Saline (medicine)

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Saline solution
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Saline
Saline solution for intravenous infusion
Clinical data
AHFS/Drugs.comFDA Professional Drug Information
License data
JSmol)
  • [Na+].[Cl-]
  • InChI=1S/ClH.Na/h1H;/q;+1/p-1
  • Key:FAPWRFPIFSIZLT-UHFFFAOYSA-M

Saline (also known as saline solution) is a mixture of

osmotic demyelination syndrome.[2]

Saline is in the crystalloid family of medications.[3] It is most commonly used as a sterile 9 g of salt per litre (0.9%) solution, known as normal saline.[1] Higher and lower concentrations may also occasionally be used.[4][5] Saline is acidic, with a pH of 5.5 (due mainly to dissolved carbon dioxide).[6]

The medical use of saline began around 1831.[7] It is on the World Health Organization's List of Essential Medicines.[8] In 2020, sodium was the 274th most commonly prescribed medication in the United States, with more than 1 million prescriptions.[9][10]

Concentrations

Saline solution for irrigation

Concentrations vary from low to normal to high. High concentrations are used rarely in medicine but frequently in molecular biology.

Normal

Normal saline (NSS, NS or N/S) is the commonly used phrase for a solution of 0.90%

intravenous drips (IVs) for people who cannot take fluids orally and have developed or are in danger of developing dehydration or hypovolemia. NS is also used for aseptic purpose. NS is typically the first fluid used when hypovolemia is severe enough to threaten the adequacy of blood circulation, and has long been believed to be the safest fluid to give quickly in large volumes. However, it is now known that rapid infusion of NS can cause metabolic acidosis.[11]

The solution is 9 grams of sodium chloride (NaCl) dissolved in water, to a total volume of 1000 ml (weight per unit volume). The mass of 1 millilitre of normal saline is 1.0046 grams at 22 °C.

solute per litre) than that of blood (approximately 285).[14] However, if the osmotic coefficient (a correction for non-ideal solutions) is taken into account, then the saline solution is much closer to isotonic. The osmotic coefficient of NaCl is about 0.93,[15]
which yields an osmolarity of 0.154 × 1000 × 2 × 0.93 = 286.44. Therefore, the osmolarity of normal saline is a close approximation to the osmolarity of blood.

Usage

For medical purposes, saline is often used to

abrasions. However, research indicates that it is no more effective than potable tap water.[16] Normal saline will not burn or sting when applied.[citation needed
]

Saline is also used in

dextrose (glucose) added to maintain a safe osmolality while providing less sodium chloride. The amount of normal saline infused depends largely on the needs of the person (e.g. ongoing diarrhea or heart failure).[citation needed
]

Saline is also often used for nasal washes to relieve some of the symptoms of rhinitis and the common cold.[17] The solution exerts a softening and loosening influence on the mucus to make it easier to wash out and clear the nasal passages for both babies[18] and adults.[19] In very rare instances, fatal infection by the amoeba Naegleria fowleri can occur if it enters the body through the nose; therefore tap water must not be used for nasal irrigation. Water is only appropriate for this purpose if it is sterile, distilled, boiled, filtered, or disinfected.[20]

Sterile isotonic saline is also used to fill breast implants for use in breast augmentation surgery, to correct congenital abnormalities such as tuberous breast deformity, and to correct breast asymmetry.[21][22] Saline breast implants are also used in reconstructive surgery post-mastectomy.

Eyes

antibiotics or topical anesthetics. Eye drops sometimes do not have medications in them and are only lubricating and tear
-replacing solutions.

Nose

There is tentative evidence that saline nasal irrigation may help with long term cases of rhinosinusitis.[23] Evidence for use in cases of rhinosinusitis of short duration is unclear.[24]

Hypertonic saline

Vial of 23.4% sodium chloride

Hypertonic saline—7% NaCl solutions are considered

expectorate). 3% hypertonic saline solutions are also used in critical care settings, acutely increased intracranial pressure, or severe hyponatremia.[25] Inhalation of hypertonic saline has also been shown to help in other respiratory problems, specifically bronchiolitis.[26] Hypertonic saline is currently recommended by the Cystic Fibrosis Foundation as a primary part of a cystic fibrosis treatment regimen.[27]

An 11% solution of xylitol with 0.65% saline stimulates the washing of the nasopharynx and has an effect on the nasal pathogenic bacteria. This has been used in complementary and alternative medicine.[28]

Other

Other concentrations commonly used include:

  • Half-normal saline (0.45% NaCl), often with "D5" (5% dextrose), contains 77 mEq/L of Na and Cl and 50 g/L dextrose.
  • Quarter-normal saline (0.22% NaCl) has 39 mEq/L of Na and Cl and almost always contains 5% dextrose for osmolality reasons. It can be used alone in neonatal intensive care units.
  • Hypertonic saline may be used in perioperative fluid management protocols to reduce excessive intravenous fluid infusions and lessen pulmonary complications.[29] Hypertonic saline is used in treating hyponatremia and cerebral edema. Rapid correction of hyponatremia via hypertonic saline, or via any saline infusion > 40 mmol/L (Na+ having a valence of 1, 40 mmol/L = 40 mEq/L) greatly increases risk of central pontine myelinolysis (CPM), and so requires constant monitoring of the person's response. Water privation combined with diuretic block does not produce as much risk of CPM as saline administration does; however, it does not correct hyponatremia as rapidly as administration of hypertonic saline does. Due to hypertonicity, administration may result in phlebitis and tissue necrosis. As such, concentrations greater than 3% NaCl should normally be administered via a central venous catheter, also known as a 'central line'. Such hypertonic saline is normally available in two strengths, the former of which is more commonly administered:
    • 3% NaCl has 513 mEq/L of Na and Cl.
    • 5% NaCl has 856 mEq/L of Na and Cl.
  • NaCl solutions that are less commonly used are 7% (1200 mEq/L) and 23.4% (approx 4000 mEq/L), both of which are used (also via central line), often in conjunction with supplementary diuretics, in the treatment of traumatic brain injury.[30]
  • Dextrose
    (glucose) 4% in 0.18% saline is used sometimes for maintenance replacement.

Solutions with added ingredients

In medicine, common types of salines include:

  • Ringer's lactate solution
  • Acetated Ringer's solution
  • Oral rehydration solution
  • Intravenous sugar solutions
    • 5% dextrose in normal saline (
      D5NS
      )
    • 10% dextrose in normal saline (D10NS)
    • 5% dextrose in half-normal saline (D5HNS)
    • 10% dextrose in half-normal saline (D10HNS)

And in cell biology, in addition to the above the following are used:

History

Saline was believed to have originated during the

Edinburgh Medical School, proposed in an article to medical journal The Lancet to inject people infected with cholera with highly oxygenated salts to treat the "universal stagnation of the venous system and rapid cessation of arterialisation of the blood" seen in people with severely dehydrated cholera.[31] He found his treatment harmless in dogs, and his proposal was soon adopted by the physician Thomas Latta in treating people with cholera to beneficial effect. In the following decades, variations and alternatives to Latta's solution were tested and used in treating people with cholera. These solutions contained a range of concentrations of sodium, chloride, potassium, carbonate, phosphate, and hydroxide. The breakthrough in achieving physiological concentrations was accomplished by Sydney Ringer in the early 1880s,[32] when he determined the optimal salt concentrations to maintain the contractility of frog heart muscle tissue. Normal saline is considered a descendant of the pre-Ringer solutions, as Ringer's findings were not adopted and widely used until decades later. The term "normal saline" itself appears to have little historical basis, except for studies done in 1882–83 by Dutch physiologist Hartog Jacob Hamburger; these in vitro studies of red cell lysis suggested incorrectly that 0.9% was the concentration of salt in human blood (rather than 0.6%, the true concentration).[33]

Normal saline has become widely used in modern medicine, but due to the mismatch with real blood, other solutions have proved better. The 2018 publication of a randomized, controlled trial with 15,000 people in

lactated Ringer's solution reduced the combined risk of mortality, need for additional dialysis, or persistent kidney problems from 15% to 14%, which given the large number of patients is a significant reduction.[34]

Society and culture

Coconut water has been used in place of normal saline in areas without access to normal saline.[35] Its use, however, has not been well studied.[35]

References

  1. ^ a b c d "Sodium Chloride Injection - FDA prescribing information, side effects and uses". www.drugs.com. Archived from the original on 18 January 2017. Retrieved 14 January 2017.
  2. ^ .
  3. from the original on 18 September 2017.
  4. ^ "Hypertonic Saline - FDA prescribing information, side effects and uses". www.drugs.com. Archived from the original on 18 January 2017. Retrieved 14 January 2017.
  5. from the original on 18 September 2017.
  6. .
  7. from the original on 18 September 2017.
  8. . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  9. ^ "The Top 300 of 2020". ClinCalc. Retrieved 7 October 2022.
  10. ^ "Sodium Salts - Drug Usage Statistics". ClinCalc. Retrieved 7 October 2022.
  11. PMID 10319767
    .
  12. ^ "Fluid Density Calculator". Earthwardconsulting.com. Archived from the original on 16 September 2009. Retrieved 27 February 2011.
  13. ^ "Water Density Calculator". Csgnetwork.com. Archived from the original on 22 January 2010. Retrieved 27 February 2011.
  14. ^ Lote CJ. Principles of Renal Physiology, 5th edition. Springer. p. 6.
  15. .
  16. ^ Brown A (20 August 2018). Ford S (ed.). "When is wound cleansing necessary and what solution should be used?". Nursing Times. Vol. 114, no. 9. Metropolis International. pp. 42–45. Retrieved 26 December 2020.
  17. ^ "Cure a cold: Saline Nasal drops". Archived from the original on 16 January 2013.
  18. ^ "Blocked Nose in Babies ('Snuffles')". Patient UK.
  19. ^ "Tixylix saline nasal drops". Netdoctor. 30 March 2011. Archived from the original on 1 November 2012.
  20. ^ "Sinus Rinsing For Health or Religious Practice". CDC. 28 February 2017.
  21. PMID 33712871
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  22. .
  23. .
  24. .
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  27. .
  28. ^ Jones A. "Intranasal Xylitol, Recurrent Otitis Media, and Asthma: Report of Three Cases*". Nasal xylitol, from Clinical Practice of Alternative Medicine. Alonzo H. Jones, DO. Archived from the original on 8 May 2014. Retrieved 7 May 2014.
  29. PMID 27271480
    .
  30. PMID 16817665. Archived from the original
    on 19 November 2010 – via Medscape.
  31. .
  32. .
  33. .
  34. ^ Dalton C (31 March 2018). "Why Did Sterile Salt Water Become The IV Fluid Of Choice?". NPR.org.
  35. ^
    PMID 10674546
    .