Hypertonic and Normal Saline Infusion Calculator
References / Background material
/ GENDER / INITIAL SODIUM
Current Sodium (Na+) level: meq/L
calculations must be confirmed before use. The authors make no claims of the accuracy of the information
contained herein; and these suggested doses are not a substitute for
clinical judgement. Neither GlobalRPh Inc. nor any other party involved
in the preparation of this program shall be liable for any special,
consequential, or exemplary damages resulting in whole or part from any
user's use of or reliance upon this material.
This Service is intended to be used for informational purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.
Target sodium level
(Should be greater than value entered above): meq/L
Maximum rate of increase:
(Note: infusion rates will
be calculated for normal saline and hypertonic saline in this section.
This program simply calculates values and does not determine
whether the generated values are clinically appropriate.)
Important notes regarding
maximum rate of increase
"Most reported cases of osmotic demyelination
occurred after rates of correction that exceeded
12 mmol per liter per day were used, but isolated
cases occurred after corrections of only 9 to 10 mmol
per liter in 24 hours or 19 mmol per liter in 48
After weighing the available evidence
and the all-too-real risk of overshooting the
mark, we recommend a targeted rate of correction
that does not exceed 8 mmol per liter on any day of
treatment. Remaining within this target, the initial
rate of correction can still be 1 to 2 mmol per liter
per hour for several hours in patients with severe
symptoms. Should severe symptoms not respond to
correction according to the specified target, we suggest
that this limit be cautiously exceeded, since the
imminent risks of hypotonicity override the potential
risk of osmotic demyelination. Recommended indications
for stopping the rapid correction of symptomatic
hyponatremia (regardless of the method used)
are the cessation of life-threatening manifestations,
moderation of other symptoms, or the achievement
of a serum sodium concentration of 125 to 130
mmol per liter (or even lower if the base-line serum
sodium concentration is below 100 mmol per liter)."1
1. Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000 May 25;342(21):1581-9.
2. Arieff AI, Ayus JC. Pathogenesis of hyponatremic encephalopathy: current concepts. Chest 1993;103(2):607-10
3. Ayus JC, Arieff AI. Pathogenesis and prevention of hyponatremic encephalopathy. Endocrinol Metab Clin North Am. 1993 Jun;22(2):425-46.
4. own RG. Disorders of water and sodium balance.
Postgrad Med. 1993 Mar;93(4):227-8, 231-4, 239-40.
5. Ellis SJ. Extrapontine myelinolysis after correction of chronic hyponatraemia with isotonic saline. Br J Clin Pract. 1995 Jan-Feb;49(1):49-50.
6. Engquist A. From plasma [Na+] to diagnosis and treatment.
Acta Anaesthesiol Scand Suppl. 1995;107:273-9.