Paediatric Acute care Guidelines PMH Emergency Department



  • The primary mechanism of action of hypertonic saline is rapid mobilisation of extravascular water into the intravascular compartment by creating a gradient in tonicity between the intravascular space and ECF
  • It may also improve cardiac effectiveness by increasing preload and by reducing after load due to hypertonic vasodilation of systemic and pulmonary vessels


  • In ED, hypertonic saline is used for the correction of severe symptomatic hyponatraemia


  • Central pontine myelinolysis due to rapid increase in serum Sodium (believed to be mainly associated with correction of chronic hyponatraemic states)
  • Volume overload
  • Hypernatraemia


Sodium Content of Solutions  Sodium (mmol/l)
3% Saline 513
20% Saline 3400
  • 3% Saline is available in 1 l bags
  • 20% Saline is available in 10ml ampoules


Via Peripheral IV:

  • 3% Saline is the preferred solution
  • 6ml / kg raises the serum sodium approximately 5 mmol/l
  • Infusion rate:  3% Saline at 0.5 – 1.0 ml/kg/hr (max rate 100ml/hr)
  • Duration:  administer over 1 hour 
  • Recheck  serum Na hourly while infusion being administered and one hour post completion of infusion


  • Hypertonic Saline may cause thrombophlebitis, therefore caution should be exercised when giving via a peripheral cannula
  • Preferred method of delivery is via a central venous catheter
  • Do not give simultaneously with blood transfusions



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