1 May 2026Infusion fluids

Sodium chloride 3% = NaCl 3%

3% sodium chloride guidance for severe symptomatic hyponatraemia, traumatic brain injury, and cerebral oedema under close supervision.

Prescription under medical supervision

This guide page is for structured reference only and does not replace a clinician, pharmacist, or emergency review. Dose choice, route choice, interactions, and safety decisions still need professional judgment.

Indications

Severe symptomatic hyponatraemia: serum sodium level under 120 mmol/litre with neurologic involvement such as seizures, confusional state, or coma.
Increased intracranial pressure in traumatic brain injury.
Cerebral oedema.

Forms and strengths, route of administration

This drug should only be used by well trained personnel in well-equipped hospitals.

Do not exceed the recommended rate of hyponatraemia correction to minimise the risk of neurologic complications.

500 ml bag, for IV infusion on a central line or large peripheral vein, preferably using an infusion pump.
Do not administer by IV, IM, or SC injection.

Composition

Hypertonic solution of sodium chloride (3 g per 100 ml, 15 g in 500 ml).

Ionic composition: sodium 513 mmol (513 mEq) per litre and chloride 513 mmol (513 mEq) per litre.

Osmolarity: 1027 mOsmol per litre.

Dose and duration

Dosage varies according to the patient's underlying condition, symptom severity, clinical response, and serum sodium level.

Do not increase serum sodium by more than 10 mmol/litre in the first 24 hours and 8 mmol/litre per 24 hours thereafter.

Severe symptomatic hyponatraemia

Check clinical response and serum sodium level. Repeat infusion up to 2 times if necessary during the first hour, until symptoms improve or serum sodium increases by 5 mmol/litre.

Further correction is based on serum sodium deficit calculation to reach 130 mmol/litre.

Child under 50 kg: 3 ml/kg over 20 minutes.
Child 50 kg and over and adult: 150 ml over 20 minutes.

Increased intracranial pressure in traumatic brain injury, cerebral oedema

Child and adult: 3 ml/kg over 10 to 20 minutes. Repeat infusion up to 2 times if necessary according to clinical response.

Contra-indications, adverse effects, precautions

Administer with caution and under close supervision to infants and older patients.
Administer with caution to patients with conditions associated with sodium or fluid retention, or taking drugs that increase that risk, and if serum sodium is over 160 mmol/litre or serum osmolarity is over 320 mOsm/litre.
May cause pain at infusion site, venous irritation, phlebitis, necrosis in the event of extravasation, nausea, vomiting, diarrhoea, dry eyes and mouth, thirst, headache, electrolyte disturbances, and acid-base imbalance.
In the event of too rapid infusion or overcorrection of hyponatraemia, may cause peripheral or pulmonary oedema and osmotic demyelination syndrome.
Closely monitor infusion rate, infusion site, clinical and neurologic state, serum sodium level, and urine output. Use an infusion pump to prevent unintentional bolus.
Pregnancy and breast-feeding: administer only if clearly needed.
Do not use as a vehicle for administering injectable drugs. Use 0.9% sodium chloride.
3% sodium chloride is not included in the WHO list of essential medicines.

Source

MSF Essential drugs practical guidelines (January 2026)

This page reproduces the structured reference information for this batch while leaving out the Storage and Remarks sections.

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