Bedside Snapshot

Use It For
Hypernatremia when sodium is also needed; adult maintenance fluid (with dextrose and K⁺); HHS when osmolality stalls despite fluids and insulin; drug diluent
Adult Dose
  • Maintenance: 25–30 mL/kg/day; all as 0.45% gives about 2 mmol/kg/day Na⁺, twice NICE's
  • Hypernatremia: per free-water deficit, ≤0.5 mEq/L/hr (max 10 mEq/L/24 hr)
  • HHS: only if osmolality stalls; Na⁺ fall max 10 mEq/L/24 hr
Pediatric Dose
DKA: after isotonic boluses, 0.45% or 0.9% sodium chloride per institutional protocol; hypernatremia: per deficit, specialist-guided. Never for boluses; isotonic for maintenance
Onset / Duration
IV: immediate / volume-based (lasts while infused); half of each liter acts as free water
Do Not Give / Hold If
Shock, hemorrhage or dehydration bolus; Na⁺ <135 mEq/L or SIADH; brain edema, TBI, stroke, intracranial hemorrhage or raised ICP; same line as blood
Watch For
Hyponatremia (headache, vomiting, confusion: STAT Na⁺); Na⁺ falling too fast during correction (serial Na⁺); fluid overload (crackles, falling SpO₂)
Reversal / Rescue
No antidote: stop the infusion. Severe symptomatic hyponatremia: 3% saline per protocol (adults 100–150 mL IV boluses; children weight-based); overload: diuretic and ventilatory support
Must Remember
Half-normal saline is half free water: it lowers Na⁺ and barely expands plasma. Give shock, sepsis, trauma and initial adult DKA fluids as isotonic crystalloid.

Indications

ED / ICU / Transport

  • Hypernatremia: free water for patients who also need some sodium. Hypovolemic hypernatremia is one example, once perfusion is back on isotonic fluid. Enteral water or D5W are the alternatives
  • Hyperosmolar hyperglycemic state (HHS): Use it only if serum osmolality is not falling despite an adequate positive fluid balance and insulin. The rise in serum sodium (Na⁺) as glucose falls is expected. On its own it is not an indication
  • Adult diabetic ketoacidosis (DKA): Not a routine step. The 2024 consensus starts with isotonic fluid, then picks fluid choice by hydration and Na⁺ (follow the local protocol)
  • Pediatric DKA: One option for deficit replacement after isotonic boluses. Follow the institutional DKA protocol
  • Interfacility transfer: Running through the transfer, either as maintenance or as the carrier for a drip

Other Uses

  • Maintenance IV fluid in adults: The label calls it a source of water and electrolytes, usually as a dextrose and potassium chloride (KCl) combination. Children aged 28 days to 18 years get isotonic maintenance fluid instead
  • Drug diluent: The label lists it as a pharmaceutic aid for compatible additives, Hospira ADD-Vantage diluent bags included. The Acetadote label calls it the preferred diluent for IV acetylcysteine. It adds that the choice depends on the patient and institutional protocol
  • Hyperosmolar diabetes when dextrose is inadvisable: Older B. Braun label wording for large fluid volumes without excess sodium. Current HHS practice starts with isotonic fluid and reaches for 0.45% only if osmolality stops falling (see the HHS dosing row)
  • Not indicated: Not for boluses in shock, sepsis, hemorrhage, trauma, burns or dehydration. Use normal saline, lactated Ringer's or Plasma-Lyte A. Not for hyponatremia either

Composition
ComponentPer LiterComparison to Plasma
Sodium chloride
4.5 g (450 mg/100 mL)
—
Na⁺
77 mEq
135–145 mEq/L: about half
Cl⁻
77 mEq
96–106 mEq/L: lower
K⁺, Ca²⁺, Mg²⁺, buffer, glucose
None (dextrose and KCl versions are separate products)
—
Osmolarity
154 mOsm/L (calculated)
Serum osmolality 275–295 mOsm/kg
pH
Nominal 5.0 (Baxter); 5.6 (B. Braun, Hospira ADD-Vantage, ICU Medical 250 mL and larger); 6.0 (ICU Medical 100 mL and smaller); range 4.5–7.0
7.35–7.45
Tonicity
Hypotonic
Lowers plasma tonicity and Na⁺
  • Free water: Think of each liter as about 500 mL of 0.9% saline plus 500 mL of electrolyte-free water
  • Where it goes: The saline half stays in the extracellular space. The free-water half spreads across total body water, mostly into cells. Far less stays in the vessels than with isotonic crystalloid
  • Chloride load: Half the chloride of 0.9% saline. Large volumes still lower Na⁺ and can cause hyponatremia
  • Products: Those are the US values above. Sterile and single-dose, with no preservative or added buffer. Discard unused portions

Dosing & Administration

Adult and pediatric doses each follow their own guidance. Adults: NICE CG174 and the 2024 adult hyperglycemic-crises consensus. Children: the AAP 2018 maintenance guideline and PECARN FLUID. Local protocols may differ.

Available Forms

  • Flexible bags: 0.45% (4.5 mg/mL; 77 mEq/L Na⁺) in 50, 100, 250, 500 and 1,000 mL single-dose containers (sizes vary by maker)
  • ADD-Vantage diluent bags (Hospira): 50, 100 and 250 mL for reconstituting compatible vial drugs
  • Look-alikes: Watch for 0.9% sodium chloride, dextrose 5% in 0.45% sodium chloride and KCl-containing versions. Read the percentage and every additive on the label

Adult Dosing

IndicationDose & RouteRepeat / MaxNotes
Routine maintenance
25–30 mL/kg/day total maintenance water IV (count all IV and enteral fluid); 20–25 mL/kg/day if older or frail, renal or cardiac failure, or at risk of refeeding
Over 2.5 L/day raises hyponatremia risk; obese: use ideal body weight, rarely over 3 L/day
NICE CG174 pairs this volume with about 1 mmol/kg/day each of Na⁺, K⁺ and Cl⁻ (its example is 0.18% sodium chloride in 4% glucose with KCl); the full volume as 0.45% gives about twice that Na⁺ (about 2 mmol/kg/day). Fluid choice varies by institution. Add dextrose and K⁺ per order; recheck electrolytes at least daily
Hypernatremia (chronic or unknown duration)
Per free-water deficit, as an IV infusion, plus ongoing losses; set and adjust the rate from repeat Na⁺ values
Lower Na⁺ by ≤0.5 mEq/L/hr (max 10 mEq/L/24 hr)
Restore perfusion with isotonic fluid first. Known acute onset (<48 hr): faster correction per specialist. In adult ICU cohorts, faster correction was not linked to higher mortality or cerebral edema, but the 0.5 mEq/L/hr limit is still expert opinion, so targets vary by institution
HHS, osmolality not falling
Switch to 0.45% sodium chloride IV, rate per protocol, only if osmolality is not falling despite an adequate positive fluid balance and insulin
Na⁺ fall max 10 mEq/L/24 hr; osmolality fall 3–8 mOsm/kg/hr, no faster than 8; glucose fall max 90–120 mg/dL/hr
Start with isotonic saline or balanced crystalloid, 500–1,000 mL/hr for the first 2–4 hr if there is no renal or cardiac compromise; replace more cautiously, with close monitoring, in older adults, pregnancy, or heart or kidney disease
DKA
Not a routine step in the 2024 adult consensus: start with 0.9% sodium chloride or balanced crystalloid; after volume is restored, fluid choice follows hydration status and Na⁺
Add dextrose 5–10% to 0.9% saline when glucose <250 mg/dL
The consensus does not describe a routine switch to 0.45%; some older protocols still switch when corrected Na⁺ is normal or high. Follow the local protocol
Drug diluent or carrier
Volume per the drug label when 0.45% is a listed diluent
Count carrier and flush volume in daily fluid and free-water totals
Hospira ADD-Vantage label: do not use with chemotherapy agents (warning given with ADDAPTOR admixing of powdered-drug vials)

Pediatric Dosing

IndicationDose (per kg) & RouteMax Single / Max TotalNotes
DKA deficit replacement
After isotonic bolus(es), 0.45% or 0.9% sodium chloride IV per institutional DKA protocol
Rate and total volume per protocol: no fixed max
In the PECARN FLUID trial, 0.45% versus 0.9% saline and fast versus slow rates did not change neurologic outcomes
Hypernatremia (specialist-guided)
Per free-water deficit, as an IV infusion, after isotonic resuscitation of any shock
Lower Na⁺ by ≤0.5 mEq/L/hr (max 10 mEq/L/24 hr)
Check Na⁺ frequently; neonates are at highest risk from rapid shifts. Adult ICU data showing no excess harm from faster correction do not apply to children: keep to the slower rate
Maintenance IV fluid (28 days–18 yr)
Not recommended: use isotonic fluid with KCl and dextrose per the AAP guideline
—
Hypotonic maintenance raises hyponatremia risk. Excluded groups (neurosurgical disorders, cardiac disease, hepatic disease, cancer, renal dysfunction, diabetes insipidus, voluminous watery diarrhea, severe burns, neonates <28 days or in the NICU): specialist-directed
Shock or dehydration bolus
Contraindicated: give isotonic crystalloid boluses
—
See normal saline or lactated Ringer's

See weight-based dosing.

Preparation & Administration

  • Line: peripheral IV is acceptable; IV only
  • Pump: run correction and maintenance infusions on a pump with a set rate and volume limit
  • Blood products: never mix or run through the same administration set as whole blood or red cells; use a 0.9% saline-primed set
  • Air embolism: use a non-vented set (or close the vent), never connect flexible bags in series, avoid pressure bags unless all air is evacuated first, and stop the pump before the bag empties
  • Additives: check compatibility, mix thoroughly, inspect for precipitate, do not store admixed bags; use premixed KCl bags rather than adding KCl at the bedside
  • Inspection: use only if the solution is clear and the container is intact (squeeze to check for leaks)
Dosing Notes:
  • Free-water deficit (L): TBW × (Na⁺ ÷ 140 − 1). Estimate TBW as weight (kg) × 0.6 in men and children, 0.5 in women and older men, 0.45 in older women, where TBW is total body water
  • Expected change per liter: ΔNa⁺ ≈ ((infusate Na⁺ + K⁺) − serum Na⁺) ÷ (TBW + 1). That is the Adrogué–Madias estimate. Plain 0.45% is 77, so add any K⁺ in the bag (with 20 mEq/L KCl, use 97)
  • Example: Picture a 70 kg man with Na⁺ 160 mEq/L and a TBW of 42 L. One liter of 0.45% drops his Na⁺ about 1.9 mEq/L (D5W about 3.7), before ongoing losses are counted
  • Estimates only: Every estimate is a moving target. Urine, stool, drain and insensible losses keep shifting, so recheck Na⁺ and redo the math

Contraindications & Precautions

Contraindications

  • Labeled: none known (Baxter, ICU Medical); B. Braun lists any situation where sodium or chloride would be clinically detrimental
  • Boluses for shock, sepsis, hemorrhage, trauma or dehydration, at any age
  • Hyponatremia or high risk of it: SIADH, postoperative state, non-osmotic vasopressin release (relative: the label says avoid; if unavoidable, monitor Na⁺)
  • Brain edema, TBI, stroke, intracranial hemorrhage or raised ICP: avoid. The label warns that hyponatremia here risks severe, irreversible, life-threatening brain injury. Use only for specialist-directed hypernatremia correction, with close Na⁺ monitoring

Precautions

  • Hyponatremic encephalopathy risk: children, premenopausal women, older adults, hypoxemia, central nervous system disease, psychogenic polydipsia, and drugs that cause hyponatremia
  • Fluid overload risk: heart failure, severe renal impairment, cirrhosis, hyperaldosteronism, pre-eclampsia and other edematous states
  • Hypernatremia or HHS correction: Lower Na⁺ or osmolality too fast and you risk cerebral edema and seizures. Osmotic demyelination has also been reported during HHS treatment
  • Lithium: Renal lithium clearance may fall. Check lithium levels

Hold / Reassess If

  • New headache, nausea, vomiting, confusion or seizure: stop, STAT Na⁺
  • Na⁺ <135 mEq/L or falling on maintenance fluid: stop, switch to isotonic fluid, notify
  • Na⁺ falling faster than 0.5 mEq/L/hr (or 10 mEq/L/24 hr) during chronic hypernatremia or HHS correction: slow or stop, notify
  • Crackles, edema or a rising oxygen requirement: stop, reassess volume
Never a Resuscitation Fluid: At 77 mEq/L Na⁺, it sits outside the 130–154 mEq/L range of resuscitation crystalloids. Half of it is free water, so it does not belong in a shock bolus. Use isotonic crystalloid for shock and dehydration.

Adverse Effects & Toxicity

Reported (Frequency Not Established)

  • Dilutional hyponatremia
  • Fluid overload and edema
  • Hypokalemia with prolonged potassium-free infusion (use a KCl-containing premix as ordered)
  • Infusion-site erythema, streaking, burning or urticaria
  • Hypersensitivity or infusion reactions: chills, fever, tremor, rash, pruritus, hypotension
  • Hyperchloremic metabolic acidosis (reported with sodium chloride injections)
  • Line or bloodstream infection (device-related)

Serious / Life-Threatening

EffectRecognitionManagement
Acute hyponatremic encephalopathy
Headache, nausea, vomiting, lethargy, seizures; highest risk in children, premenopausal women, hypoxemia, CNS disease and SIADH
Stop; STAT Na⁺; severe symptoms: 3% saline per protocol (adults 100–150 mL IV boluses; children weight-based per pediatric protocol)
Neurologic injury from too-rapid Na⁺ change
Seizure, falling level of consciousness or new deficits during hypernatremia or HHS correction; osmotic demyelination after rapid rise of chronic low Na⁺
Stop or slow; recheck Na⁺; neurologic assessment; specialist input
Pulmonary edema
Dyspnea, crackles, falling SpO₂
Stop; oxygen and ventilatory support; diuretic (furosemide)
Hypersensitivity reaction
Tachycardia, chest pain, dyspnea, flushing, urticaria, hypotension
Stop immediately; anaphylaxis: IM epinephrine per protocol
Air embolism
Sudden dyspnea, hypotension or cardiac arrest during a pressurized or series infusion
Stop the infusion and clamp the line; high-flow oxygen; resuscitate as needed

Overdose & Toxicity Management

  • Cause: usually a rate or pump error, or carrier and flush volume that nobody counted
  • Signs: Excessive 0.45% can cause hyponatremia or hypernatremia, plus fluid overload. Both Na⁺ extremes can cause seizures, coma, cerebral edema and death
  • Management: stop or reduce the infusion; monitor fluid balance, electrolytes and acid-base status; 3% saline for severe symptomatic hyponatremia; diuretics and ventilatory support for overload
  • Antidote: none

Monitoring
ParameterWhen / How OftenTarget / Act If
Laboratory: serum Na⁺
Baseline; at least daily on maintenance; every 2–4 hr during hypernatremia or HHS correction
Off the planned trajectory or <135 mEq/L: adjust or stop and notify (sodium)
Laboratory: capillary glucose (HHS or DKA)
Every 1–2 hr while on IV insulin
Below 250 mg/dL: add dextrose 5–10% and reduce insulin per protocol; in HHS, falling faster than 90–120 mg/dL/hr: slow per protocol (glucose)
Laboratory: serum osmolality (HHS)
At least every 4 hr (every 2–4 hr acceptable) with creatinine and electrolytes
Target fall 3–8 mOsm/kg/hr; falling faster than 8: slow fluids per protocol; not falling despite fluids and insulin: see the HHS dosing row
Laboratory: K⁺, chloride, bicarbonate, renal function
Baseline and at least daily; every 2–4 hr in HHS or DKA
Low K⁺: replace; rising creatinine or acid-base change: review fluid plan (potassium, chloride, creatinine)
Laboratory: lithium level
During concomitant lithium therapy
Rising level: notify prescriber
Clinical: neurologic status
Every assessment during dysnatremia or HHS treatment
Headache, vomiting, confusion or seizure: stop, STAT Na⁺
Clinical: intake, output and weight
Hourly urine output during correction; fluid balance chart daily; weight twice weekly on prolonged therapy
High urine output (diabetes insipidus, osmotic diuresis): recalculate losses
Clinical: lungs and SpO₂
Every assessment
Crackles, edema or falling SpO₂: stop, reassess volume
Infusion Safety: bag and rate
Start, bag change, handoff
Right fluid (0.45%, not 0.9% or a dextrose/KCl version unless ordered), pump rate matches order, carrier volumes counted

Interactions & Compatibility

Clinically Significant Interactions

Drug / ClassEffectWhat To Do
Drugs associated with hyponatremia: diuretics, certain antiepileptic and psychotropic drugs, drugs that increase vasopressin effect (desmopressin)
Impaired free-water excretion plus added free water: hyponatremia
Avoid 0.45%; if unavoidable, monitor Na⁺ closely
Lithium
Renal sodium and lithium clearance may decrease
Monitor lithium levels
Corticosteroids, corticotropin
Sodium and fluid retention: edema, overload
Avoid if possible (Baxter label); if unavoidable, monitor electrolytes, fluid balance and acid-base status

IV Compatibility

  • Blood products: never in the same administration set as whole blood or cellular components (hypotonic: risk of red-cell hemolysis); use 0.9% sodium chloride
  • Additives: may be incompatible; evaluate each drug's label and consult pharmacy; discard if discoloration, precipitate or crystals appear
  • ADD-Vantage bags (Hospira): label warning with the ADDAPTOR for powdered-drug vials: do not use with chemotherapy agents
  • Verify with an institutional compatibility resource.

Special Populations
  • Pediatrics: Kids carry the higher risk of hyponatremia and hyponatremic encephalopathy. For ages 28 days to 18 years, the AAP recommends isotonic maintenance fluid with KCl and dextrose. Save 0.45% for calculated deficit therapy, DKA included, per protocol. See the Pediatric Dosing table.
  • Neonates: Under 28 days or in the NICU, they fall outside the AAP guideline. Fluid choice is specialist-directed. In very-low-birth-weight infants, excessive or rapid sodium chloride raises serum osmolality and the risk of intracerebral hemorrhage.
  • Pregnancy: The label reports no adequate studies. Use it only if the potential benefit justifies the potential risk to the fetus. Pre-eclampsia raises the risk of fluid overload, edema and hypernatremia. The 2024 hyperglycemic-crises consensus lists pregnancy among the groups that need caution with rapid fluid replacement. Limit volume and monitor.
  • Lactation: The label says it is not known whether the drug passes into human milk, and it advises caution. Sodium and water are normal milk constituents. No infant harm is expected at therapeutic volumes.
  • Older Adults: Electrolyte imbalance, hyponatremia and overload come more easily here. Start at the low end, 20–25 mL/kg/day for maintenance, and monitor renal function.
  • Renal Impairment: No dose adjustment is established. Severe impairment raises the risk of fluid overload and Na⁺ disturbance. Avoid if possible, or monitor closely.
  • Hepatic Impairment: No specific adjustment is established. Cirrhosis with secondary hyperaldosteronism raises the risk of edema and overload.
  • Obesity / Dosing Weight: Base maintenance volume on ideal body weight. Patients rarely need more than 3 L/day. Free-water deficit formulas are only estimates, so titrate to measured Na⁺.
  • Acute Brain Injury: Hypotonic fluid is a bad fit here. Avoid it in brain edema, TBI, stroke, intracranial hemorrhage or raised ICP.

Field & Transport Considerations
  • Scope: Rarely started in the field. Paramedic, RN and critical-care transport (Paramedic/RN/CCT) maintain it during interfacility transfer. Scope varies by state and agency protocol.
  • Storage & Stability: store at room temperature (25°C (77°F)) in the overwrap until use; brief exposure up to 40°C (104°F) does not harm Baxter product; protect from freezing; avoid excessive vehicle heat.
  • Carried Concentration: The 0.45% and 0.9% bags look alike, and so do the dextrose and KCl versions. Read the percentage and additives before you spike.
  • Infusions in Transport: pump only, with a volume limit; no pressure bags unless all air is evacuated; never connect bags in series; count carrier and flush volume.
  • Shock en Route: Hypotension is not a reason to speed up a 0.45% line. Give isotonic crystalloid or blood through a separate saline-primed line.
  • Handoff Essentials: Hand off the indication, current rate and total volume given, the Na⁺ trend (and glucose or osmolality in HHS) with times and next draw due, and urine output. The receiving team reassesses fluid status on arrival.

Clinical Pearls
Half Free Water, Not Volume: Half of each liter is free water, and most of it moves into cells. Hypotension needs isotonic crystalloid or blood. Not half-normal saline.
Exam Discriminator, Rising Na⁺ in HHS: Na⁺ climbs about 1.6 mEq/L for every 100 mg/dL that glucose falls, because water shifts into cells. Expect it. It is not a reason to switch to 0.45%. Switch only if osmolality stops falling despite fluids and insulin.
0.45% vs D5W for Hypernatremia: A liter of 0.45% lowers Na⁺ about half as much as a liter of D5W, so you need roughly twice the volume. Patient needs sodium and volume too? Choose 0.45%. Volume is the problem? Choose D5W or enteral water.
Old DKA Teaching: The switch to 0.45% at normal or high corrected Na⁺ came from older ADA algorithms. The 2024 adult consensus starts with 0.9% saline or balanced crystalloid. Later fluid choice follows hydration and Na⁺. Dextrose goes in when glucose falls below 250 mg/dL. A routine switch to 0.45% is not part of it.
Pediatric Maintenance Has Changed: For decades, pediatric maintenance meant hypotonic fluid. Now the AAP recommends isotonic fluid with KCl and dextrose for most children. Hypotonic fluid causes hospital-acquired hyponatremia, and that is why the standard changed.
Crystalloids Compared (Na⁺ / Cl⁻ mEq/L; osmolarity):
  • 0.45% NaCl: 77 / 77; 154 mOsm/L (hypotonic)
  • 0.9% NaCl: 154 / 154; 308 mOsm/L (isotonic)
  • Lactated Ringer's: 130 / 109; 273 mOsm/L (slightly hypotonic)
  • Plasma-Lyte A: 140 / 98; 294 mOsm/L
  • D5W: 0 / 0; 252 mOsm/L in the bag, free water once the dextrose is used

Pharmacology

Mechanism of Action

  • Supplies sodium and chloride at half the plasma concentration → adds electrolyte-free water → lowers plasma tonicity and Na⁺
  • The saline fraction stays extracellular → modest extracellular volume expansion
  • The free-water fraction distributes across total body water → water enters cells → corrects cellular dehydration in hypernatremia, but swells brain cells when Na⁺ is normal or low
  • The kidneys control Na⁺ and Cl⁻ balance. Non-osmotic vasopressin release (pain, nausea, surgery, SIADH) blocks free-water excretion and drives hyponatremia

Pharmacokinetics

RouteOnsetPeakDuration
IV infusion
Immediate
Depends on rate and distribution
Volume-based: lasts while the infusion runs
  • Half-life: no meaningful drug half-life; the effect follows rate, volume and renal water handling
  • Metabolism: none; sodium and chloride are physiologic ions
  • Elimination: renal; excretion depends on vasopressin, the renin-angiotensin-aldosterone system and kidney function

Names & Classification
Generic Name
Sodium Chloride Injection, USP 0.45% (half-normal saline, ½NS)
Brand Names
Generic; US makers include Baxter (VIAFLEX container), B. Braun (EXCEL container), ICU Medical, and Hospira (ADD-Vantage diluent bags)
Pharmacologic Class
Hypotonic crystalloid (electrolyte solution)
Therapeutic Class
IV fluid; free-water and electrolyte source; drug diluent
Controlled Substance
Not controlled
ISMP High-Alert
No (the ISMP list includes sodium chloride more concentrated than 0.9%, not 0.45%)
Look-Alike / Sound-Alike
None commonly reported as a named pair; in practice, 0.45% and 0.9% bags and dextrose or KCl versions look alike

Related

References
  1. Baxter Healthcare Corporation. (2024). Sodium Chloride Injection, USP (0.45% and 0.9%) in VIAFLEX plastic container: Prescribing information. DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f55bd888-5e01-474d-871b-24654c070178
  2. ICU Medical. (2025). Sodium Chloride Injection, USP (0.45% and 0.9%). DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5f372b75-d7a4-471e-8ac6-290040fc84b0; B. Braun. (2024). 0.45% and 0.9% Sodium Chloride Injection USP. DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7f22c06b-6b4d-4b49-a4b2-d2169f2bd653
  3. Hospira. (2026). Sodium Chloride Injection, USP in ADD-Vantage diluent container. DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a2a964f7-c3ec-4dfb-e3a0-6d8136a80397
  4. Umpierrez, G. E., Davis, G. M., ElSayed, N. A., et al. (2024). Hyperglycemic crises in adults with diabetes: A consensus report. Diabetes Care, 47(8), 1257–1275. https://doi.org/10.2337/dci24-0032
  5. National Institute for Health and Care Excellence. (2017). Intravenous fluid therapy in adults in hospital (Clinical guideline CG174; published 2013, updated 2017). https://www.nice.org.uk/guidance/cg174
  6. Spasovski, G. (2024). Hyponatraemia: Treatment standard 2024. Nephrology Dialysis Transplantation, 39(10), 1583–1592. https://doi.org/10.1093/ndt/gfae162
  7. Feld, L. G., Neuspiel, D. R., Foster, B. A., et al. (2018). Clinical practice guideline: Maintenance intravenous fluids in children. Pediatrics, 142(6), e20183083. https://doi.org/10.1542/peds.2018-3083
  8. Kuppermann, N., Ghetti, S., Schunk, J. E., et al. (2018). Clinical trial of fluid infusion rates for pediatric diabetic ketoacidosis (PECARN FLUID). New England Journal of Medicine, 378(24), 2275–2287. https://doi.org/10.1056/NEJMoa1716816
  9. Adrogué, H. J., & Madias, N. E. (2000). Hypernatremia (landmark review). New England Journal of Medicine, 342(20), 1493–1499. https://doi.org/10.1056/NEJM200005183422006
  10. Chauhan, K., Pattharanitima, P., Patel, N., et al. (2019). Rate of correction of hypernatremia and health outcomes in critically ill patients. Clinical Journal of the American Society of Nephrology, 14(5), 656–663. https://doi.org/10.2215/CJN.10640918
  11. Baxter Healthcare Corporation. (2025). Lactated Ringer's Injection, USP, in VIAFLEX plastic container: Prescribing information. DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=dad7735c-709b-40ea-ab7a-15577e24a966
  12. Baxter Healthcare Corporation. (2019). PLASMA-LYTE A Injection pH 7.4 (Multiple Electrolytes Injection, Type 1, USP) in VIAFLEX plastic container: Prescribing information (text revised August 2019). DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6ec9e61c-2c26-402f-8604-f446b2e34058

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