Saline (medicine)
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Saline (also known as saline solution) is a mixture of
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
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%
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.
Usage
For medical purposes, saline is often used to
Saline is also used in
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
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
Hypertonic saline—7% NaCl solutions are considered
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)
- 5% dextrose in normal saline (
And in cell biology, in addition to the above the following are used:
- Phosphate buffered saline(PBS) (recipes from Dulbecco = D-PBS, Galfre, Kuchler, Ausubel etc.)
- TRIS-buffered saline(TBS) (recipes from Goldsmith, Ausubel etc.)
- Hank's balanced salt solution (HBSS)
- Earle's balanced salt solution (EBSS)
- Standard saline citrate (SSC)
- HEPES-buffered saline (HBS) (recipes from Dittmar, Liu, Ausubel etc.)
- Gey's balanced salt solution (GBSS)
History
Saline was believed to have originated during the
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
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
- ^ 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.
- ^ ISBN 9780857111562.
- ISBN 9780781798396. Archivedfrom the original on 18 September 2017.
- ^ "Hypertonic Saline - FDA prescribing information, side effects and uses". www.drugs.com. Archived from the original on 18 January 2017. Retrieved 14 January 2017.
- ISBN 9780781724258. Archivedfrom the original on 18 September 2017.
- PMID 23630439.
- ISBN 9781780643113. Archivedfrom the original on 18 September 2017.
- hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
- ^ "The Top 300 of 2020". ClinCalc. Retrieved 7 October 2022.
- ^ "Sodium Salts - Drug Usage Statistics". ClinCalc. Retrieved 7 October 2022.
- PMID 10319767.
- ^ "Fluid Density Calculator". Earthwardconsulting.com. Archived from the original on 16 September 2009. Retrieved 27 February 2011.
- ^ "Water Density Calculator". Csgnetwork.com. Archived from the original on 22 January 2010. Retrieved 27 February 2011.
- ^ Lote CJ. Principles of Renal Physiology, 5th edition. Springer. p. 6.
- .
- ^ 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.
- ^ "Cure a cold: Saline Nasal drops". Archived from the original on 16 January 2013.
- ^ "Blocked Nose in Babies ('Snuffles')". Patient UK.
- ^ "Tixylix saline nasal drops". Netdoctor. 30 March 2011. Archived from the original on 1 November 2012.
- ^ "Sinus Rinsing For Health or Religious Practice". CDC. 28 February 2017.
- PMID 33712871.
- S2CID 145932734.
- PMID 31087631.
- S2CID 9798807.
- PMID 21330456.
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- S2CID 26080152.
- ^ 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.
- PMID 27271480.
- PMID 16817665. Archived from the originalon 19 November 2010 – via Medscape.
- .
- ISBN 978-0-7817-4802-5.
- PMID 18313809.
- ^ Dalton C (31 March 2018). "Why Did Sterile Salt Water Become The IV Fluid Of Choice?". NPR.org.
- ^ PMID 10674546.