Hypertonic saline (Sodium Chloride 3%) administration


These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

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To guide staff in the administration of hypertonic saline.


  • 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 and raised intercranial pressure.

Adverse reactions

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

Dosage, administration and monitoring

Refer to PCH Medication Monograph - Hypertonic Saline (Sodium Chloride 3% and 23.4%) (internal WA Health only)

Reviewer/Team: ED Heads of Department, ED Consultant, ED Nursing Staff
Last reviewed: Aug 2021

Review date: Aug 2024
Endorsed by:

Executive Director, Medical Services Date:  Aug 2021

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