Sodium chloride 0.9% — FY prescribing 💊
🚨 HIGH ALERT — EDUCATIONAL DRAFT, NOT A PRESCRIBING ORDER. Drug choice, indication, formulation, dose, route and monitoring require current BNF/BNFC, product SmPC and local NHS protocol. Source reviewed 3 November 2026; independent clinical/pharmacy sign-off pending.
🧬 Mechanism and reason for use
- Sodium chloride 0.9% expands extracellular fluid volume but can deliver a large chloride load.
- Resuscitation in selected hypotensive adults; replacement fluid and specific medication carrier/clinical indications.
💊 Indication-specific UK regimen / dosing boundary
- Adult IV fluid resuscitation: NICE CG174 recommends a crystalloid containing sodium 130–154 mmol/L, typically 500 mL over less than 15 minutes, followed by reassessment. This is a resuscitation bolus, not routine maintenance.
- Routine adult maintenance: NICE CG174 initially suggests 25–30 mL/kg/day fluid, with lower 20–25 mL/kg/day in older/frail, renal/cardiac failure or refeeding-risk patients. Match electrolyte/glucose requirements, not simply repeated normal-saline bags.
🔎 Before writing a prescription
- Assess indication, shock state, recent fluid balance, weight, cardiac/renal disease, serum sodium, chloride and acid-base status.
🧪 Monitoring and reassessment
- BP, perfusion, respiratory examination, oxygenation, input-output, daily weight and electrolytes; reassess each bolus.
🚨 Serious pitfalls / when to escalate
- Hyperchloraemic acidosis and fluid overload with excessive saline; not every hypotensive patient is fluid responsive.
- Paediatric fluids require weight/age-specific NICE NG29 guidance.
📖 UK reference documents
Editorial status: Source checked for the specific statements above on 3 November 2026. References may be updated. This card has not had formal independent pharmacist/consultant approval; no unlisted indications, paediatric extrapolation or automatic renal-dose adjustments are implied.
