Half-normal saline

Sodium is essential for the maintenance of normal heart action and in the regulation of osmotic pressure in body cells. Sodium, as sodium chloride (NaCl), may be given IV. A solution containing 0.9% NaCl is called normal saline, and a solution containing 0.45% NaCl is called half-normal saline. Sodium also is available combined with dextrose, for example, dextrose 5% and sodium chloride 0.9%. 

Half-normal saline is a hypotonic fluid that provides free water in relative excess when compared to the sodium concentration. This crystalloid is typically used to treat patients... 

Vigorous intravenous hydration with dextrose 5% in water with half-normal saline at 3 L/m2 per day to maintain a urine output of 100 mL/m2 per hour or more is necessary, unless the patient presents with acute renal dysfunction. Alkalinization of the urine to a pH of 7.0 or more with 50 to 100 mEq/L of sodium bicarbonate has been used to promote uric acid solubility for excretion. This measure is controversial because xanthine and hypoxanthine are less soluble at alkaline pH, potentially leading to crystallization, especially during and after allopurinol therapy32 (see Fig. 96-6). Medications that increase serum... 

Administer sodium chloride intravenously as half-normal saline (D50/0.5 NS) at a rate sufficient to obtain a urine output of 4-6 mL/kg/h. Furosemide, 1 mg/kg, may assist urinary excretion. 

In dehydrated patients, replace fluid deficits with intravenous crystalloid solutions. Initial treatment should Include repletion of sodium and water with 1-2 L of normal saline (children 10-20 mL/kg). Once fluid deficits are replaced, give hypotonic (eg, half-normal saline) solutions because continued administration of normal saline often leads to hypernatremia, especially in patients with lithium-induced nephrogenic diabetes insipidus. 

Intravenous fluids—half-normal saline so that levels will not drop greatly, likely over 100 mL/h. 

In a number of methods, isolation of the nucleoprotein complex (stage 2) is avoided. In the isolation of ribonucleic acid from beef pancreas,1241 nuclear material and cell debris are removed from a normal-saline extract of the minced tissue, which is then brought to half-saturation with sodium chloride (to dissociate the protein from the nucleic acid). After removal of the protein, the nucleic acid is precipitated with alcohol. However, the suggestion has been made126 that it is more satisfactory to isolate the nucleoprotein first, and this has been carried out, for instance, in the extraction of the ribonucleic acid from fowl sarcoma GRCH 15.126 Nucleoprotein complexes have also been isolated from baker s yeast127 and have been separated into various fractions, the nucleic acids from which differ slightly in composition. In addition, nucleoproteins have been isolated by complex formation with cetyltrimethylammonium bromide.128... 

Half strength of normal saline Ringer s lactate... 

Of the prophylactic agents, hydration is unanimously endorsed, Its theorized mechanism of action is the enhancement of renal perfusion and, conversely, the minimization of ischemia. While it has become the standard of care based on a multitude of early trials (85,86), no large, prospective studies have been conducted. The optimal method of hydration has yet to be decided, with one study showing benefit of normal saline (0.9% NS) over half NS (0.45%) (87), and another study suggesting that 154 mEq/L of sodium bicarbonate is superior to NS alone, Of note, the total volume in the latter study was less than that was used in other trials, making it difficult to compare (88). Thus, currently, NS should be used unless the patient is highly intolerant to volume administration, In such a case, 154 mEq/L of sodium bicarbonate can be administered over a shorter time period,... 

Ifosfamide usually is administered in a short infusion in. 1% dextrose or normal. saline. Use within 8 hours of reconstitution is recommended. Pharmacokinetic studies indicate that it is handled in the same way as cyelophusphainide. except that metabolism is less extensive. There is an appareiil half-life trf 7 hours und a urinary recovery of 13%. 

The dose of ammonium chloride can be calculated on the basis of the chloride deficit using the same method as for HCl, using the conversion of 20 g ammonium chloride providing 374 mEq of H . However, only half of the calculated dose of ammonium chloride should be administered so as to avoid ammonia toxicity. Ammonium chloride is available as a 26.75% solution containing 100 mEq in 20 mL, which should be further diluted prior to administration. A dilute solution may be prepared by adding 100 mEq of ammonium chloride to 500 mL of normal saline and infusing the solution at a rate of no more than 1 mEq/min. Improvement in metabolic stams is usually seen within 24 hours. CNS toxicity, marked by confusion, irritability, seizures, and coma, has been associated with more rapid rates of administration. Ammonium chloride must be administered cautiously to patients with renal or hepatic impairment. In patients with hepatic dysfunction, impaired conversion of ammonia to urea may result in increased ammonia levels and worsened encephalopathy. In patients with renal failure, the increased urea synthesis may exacerbate uremic symptoms. ... 

Pentostatin (Nipent) is available for IV nse. The recommended dosage is 4 mg/m administered every other week. After hydration with 500 to 1000 mL of 5% dextrose in half-normal (0.45%) saline, the drng is administered by rapid IV injection or by infnsion dnring a period of np to 30 minntes, followed by an additional 500 mL of flnids. Extravasation does not prodnce tissne necrosis. 

Treprostinil (Fig. 29.13) is a synthetic, stable form of prostacyclin for the treatment for advanced pulmonary hypertension with NYHA class III or IV symptoms as well as for late-stage peripheral vascular disease (PVD). Its sodium salt injectable form is administered either as a continuous subcutaneous infusion directly into the skin or, if the subcutaneous infusion is not tolerated, as a continuous IV infusion without an implanted catheter. Treprostinil is rapidly absorbed from the subcutaneous site of infusion, with an almost 100% bioavailability and a mean half-life of 85 minutes (34 minutes for the IV infusion). The IV solution must be diluted with normal saline or sterile water before starting the infusion. Unlike epoprostenol, treprostinil is stable at room temperature for up to 5 years, with vasodilation action lasting from 4 to 6 hours, compared with the short, 2- to 3-minute action for epoprostenol. Because of its long life in the body, it can be administered under the skin with a microinfusion subcutaneous infusion pump rather than into the bloodstream and, thus, without hospitalization, as contrasted with the central IV infusion of epoprostenol. 

E. Begin intravenous infusion of normal saline (NS), 5% dextrose in NS (DSNS), 5% dextrose in half NS (D5W 0.45% sodium chloride), or 5% dextrose in water (D5W) at a keep-open rate for children, use 5% dextrose in quarter NS (D5W 0.25% sodium chloride). If the patient is hypotensive (see p 16), NS or another isotonic crystalloid solution is preferred. 

A direct geochemical check on the particle flux of organic matter from the euphotic zone determined by sediment traps is achieved by using the mass balance of thorium isotopes in surface waters. Since decay systematics and chemistry of the uranium series isotopes were introduced in Chapter 5, we will only briefly reiterate them here. is relatively unreactive in oxic seawater and exists in the ocean as a conservative element, i.e. the concentration normalized to salinity is everywhere the same to within measurement error. decays to which is very reactive to particles and has a relatively short radioactive half life of 24.1 d ... 

---