BNF for Children 2011-2012

462 9.2.2 Parenteral preparations for fluid & electrolyte imbalance BNFC 2011–20129 Nutrition and bloodhypernatraemia and hyponatraemia can cause fits andrarely brain damage. Sodium in drug preparations,delivered via continuous infusions, or in infusions tomaintain the patency of intravascular or umbilical lines,can result in significant amounts of sodium being delivered,(e.g. 1 mL/hour of 0.9% sodium chloride infusedover 24 hours is equivalent to 3.6 mmol/day of sodium).SODIUM CHLORIDECautions restrict intake in impaired renal function,cardiac failure, hypertension, peripheral and pulmonaryoedema, toxaemia of pregnancy; see also notesaboveSide-effects administration of large doses may giverise to sodium accumulation and oedemaIndication and doseElectrolyte imbalance see notes above, also section9.2.1.2Sodium Chloride (Non-proprietary) AIntravenous infusion, usual strength sodium chloride0.9% (9 g, 150 mmol each of Na + and Cl /litre), thisstrength being supplied when normal saline forinjection is requested. Net price 2-mL amp = 32p; 5-mL amp = 38p; 10-mL amp = 52p; 20-mL amp =£1.04; 50-mL amp = £3.63In hospitals, 500- and 1000-mL packs, and sometimes other sizes,are availableNote The term ‘normal saline’ should not be used todescribe sodium chloride intravenous infusion 0.9%; theterm ‘physiological saline’ is acceptable but it is preferable togive the composition (i.e. sodium chloride intravenous infusion0.9%).With other ingredientsNote See above for warning on hyponatraemiaSodium Chloride and Glucose (Non-proprietary) AIntravenous infusion, sodium chloride 0.18% (Na +and Cl – each 30 mmol/litre), glucose 4%In hospitals, usually 500-mL packs and sometimes other sizes areavailableIntravenous infusion, sodium chloride 0.45% (Na +and Cl – each 75 mmol/litre), glucose 5%In hospitals, usually 500-mL packs and sometimes other sizes areavailableIntravenous infusion, sodium chloride 0.9% (Na +and Cl – each 150 mmol/litre), glucose 5%In hospitals, usually 500-mL packs and sometimes other sizes areavailableRinger’s Solution (Non-proprietary) ACalcium chloride (dihydrate) 322 micrograms, potassiumchloride 300 micrograms, sodium chloride8.6 mg/mL, providing the following ions (in mmol/litre), Ca 2þ 2.2, K + 4, Na + 147, Cl 156In hospitals, 500- and 1000-mL packs, and sometimes other sizes,are availableSodium Lactate, Compound (Non-proprietary) A(Hartmann’s Solution; Ringer-Lactate Solution)Intravenous infusion, sodium chloride 0.6%, sodiumlactate 0.32%, potassium chloride 0.04%, calciumchloride 0.027% (containing Na + 131 mmol, K +5 mmol, Ca 2þ 2 mmol, HCO 3 (as lactate) 29 mmol,Cl 111 mmol/litre)In hospitals, 500- and 1000-mL packs, and sometimes other sizes,are availableIntravenous glucoseGlucose solutions are used mainly to replace waterdeficit and should not be given alone except whenthere is no significant loss of electrolytes; prolongedadministration of glucose solutions without electrolytescan lead to hyponatraemia and other electrolyte disturbances.Water depletion (dehydration) tends to occurwhen losses are not matched by a comparable intake, asmay occur in coma or dysphagia.Water loss rarely exceeds electrolyte losses but this canoccur in fevers, hyperthyroidism, and in uncommonwater-losing renal states such as diabetes insipidus orhypercalcaemia. The volume of glucose solution neededto replace deficits varies with the severity of the disorder;the rate of infusion should be adjusted to returnthe plasma-sodium concentration to normal over 48hours.Glucose solutions are also used to correct and preventhypoglycaemia and to provide a source of energy inthose too ill to be fed adequately by mouth; glucosesolutions are a key component of parenteral nutrition(section 9.3).Glucose solutions are given with insulin for the emergencymanagement of hyperkalaemia (see p. 458).They are also given, after correction of hyperglycaemia,during treatment of diabetic ketoacidosis, when theymust be accompanied by continuous insulin infusion(section 6.1.3).Injections containing more than 10% glucose can beirritant and should be given into a central venous line;however, solutions containing up to 12.5% can beadministered for a short period into a peripheral line.GLUCOSE(Dextrose Monohydrate)Note Glucose BP is the monohydrate but Glucose IntravenousInfusion BP is a sterile solution of anhydrous glucoseor glucose monohydrate, potency being expressed in termsof anhydrous glucoseSide-effects glucose injections especially if hypertonicmay have a low pH and may cause venousirritation and thrombophlebitisIndication and doseFluid replacement see notes aboveProvision of energy section 9.3Hypoglycaemia section 6.1.4Glucose (Non-proprietary) AIntravenous infusion, glucose or anhydrous glucose(potency expressed in terms of anhydrous glucose),usual strengths 5% (50 mg/mL), 10% (100 mg/mL),and 20% (200 mg/mL); 20% solution, net price 20-mLamp = £2.04; 50% solution 1 , 20-mL amp = 95 p, 50-mL vial = £2.13In hospitals, 500- and 1000-mL packs, and sometimes other sizesand strengths, are available; also available Minijet c Glucose, 50%in 50-mL disposable syringe 11. A restriction does not apply where administration is forsaving life in emergency