Saline (medicine)

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Saline
NaCl 0,9%25 500ml white background.jpg
Saline solution for intravenous infusion
Clinical data
AHFS/Drugs.com FDA Professional Drug Information
License data
Routes of
administration 		Intravenous, topical, subcutaneous
ATC code
Identifiers
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
Chemical and physical data
Formula ClNa
Molar mass 58.44 g·mol−1
3D model (JSmol)
  • [Na+].[Cl-]
  • InChI=1S/ClH.Na/h1H;/q;+1/p-1
  • Key:FAPWRFPIFSIZLT-UHFFFAOYSA-M

Saline (also known as saline solution) is a mixture of sodium chloride (salt) and water. [1] It has a number of uses in medicine including cleaning wounds, removal and storage of contact lenses, and help with dry eyes. [2] By injection into a vein, it is used to treat hypovolemia such as that from gastroenteritis and diabetic ketoacidosis. [2] [1] Large amounts may result in fluid overload, swelling, acidosis, and high blood sodium. [1] [2] In those with long-standing low blood sodium, excessive use may result in osmotic demyelination syndrome. [2]

Contents

Saline is in the crystalloid family of medications. [3] It is most commonly used as a sterile 9 g of salt per litre (0.9%) solution, known as normal saline. [1] Higher and lower concentrations may also occasionally be used. [4] [5] Saline is acidic, with a pH of 5.5 (due mainly to dissolved carbon dioxide). [6]

The medical use of saline began around 1831. [7] It is on the World Health Organization's List of Essential Medicines. [8] In 2020, sodium was the 274th most commonly prescribed medication in the United States, with more than 1 million prescriptions. [9] [10]

Normal concentration

Saline solution for irrigation Baxter sodium chloride irrigation.JPG
Saline solution for irrigation

Normal saline (NSS,NS or N/S) is the commonly used phrase for a solution of 0.90% w/v of NaCl, 308 mOsm/L or 9.0 g per liter. Less commonly, this solution is referred to as physiological saline or isotonic saline (because it is approximately isotonic to blood serum, which makes it a physiologically normal solution). Although neither of those names is technically accurate because normal saline is not exactly like blood serum, they convey the practical effect usually seen: good fluid balance with minimal hypotonicity or hypertonicity. NS is used frequently in intravenous drips (IVs) for people who cannot take fluids orally and have developed or are in danger of developing dehydration or hypovolemia. NS is also used for aseptic purpose. NS is typically the first fluid used when hypovolemia is severe enough to threaten the adequacy of blood circulation, and has long been believed to be the safest fluid to give quickly in large volumes. However, it is now known that rapid infusion of NS can cause metabolic acidosis. [11]

The solution is 9 grams of sodium chloride (NaCl) dissolved in water, to a total volume of 1000 ml (weight per unit volume). The mass of 1 millilitre of normal saline is 1.0046 grams at 22 °C. [12] [13] The molecular weight of sodium chloride is approximately 58.4 grams per mole, so 58.4 grams of sodium chloride equals 1 mole. Since normal saline contains 9 grams of NaCl, the concentration is 9 grams per litre divided by 58.4 grams per mole, or 0.154 mole per litre. Since NaCl dissociates into two ions – sodium and chloride – 1 molar NaCl is 2 osmolar. Thus, NS contains 154 mEq/L of Na+ and the same amount of Cl−. This points to an osmolarity of 154 + 154 = 308, which is higher (i.e. more solute per litre) than that of blood (approximately 285). [14] However, if the osmotic coefficient (a correction for non-ideal solutions) is taken into account, then the saline solution is much closer to isotonic. The osmotic coefficient of NaCl is about 0.93, [15] which yields an osmolarity of 0.154 × 1000 × 2 × 0.93 = 286.44. Therefore, the osmolarity of normal saline is a close approximation to the osmolarity of blood.

Usage

For medical purposes, saline is often used to flush wounds and skin abrasions. However, research indicates that it is no more effective than potable tap water. [16] Normal saline will not burn or sting when applied.[ citation needed ]

Saline is also used in I.V. therapy, intravenously supplying extra water to rehydrate people or supplying the daily water and salt needs ("maintenance" needs) of a person who is unable to take them by mouth. Because infusing a solution of low osmolality can cause problems such as hemolysis, intravenous solutions with reduced saline concentrations (less than 0.9%) typically have dextrose (glucose) added to maintain a safe osmolality while providing less sodium chloride. The amount of normal saline infused depends largely on the needs of the person (e.g. ongoing diarrhea or heart failure).[ citation needed ]

Saline is also often used for nasal washes to relieve some of the symptoms of rhinitis and the common cold. [17] The solution exerts a softening and loosening influence on the mucus to make it easier to wash out and clear the nasal passages for both babies [18] and adults. [19] In very rare instances, fatal infection by the amoeba Naegleria fowleri can occur if it enters the body through the nose; therefore tap water must not be used for nasal irrigation. Water is only appropriate for this purpose if it is sterile, distilled, boiled, filtered, or disinfected. [20]

Sterile isotonic saline is also used to fill breast implants for use in breast augmentation surgery, to correct congenital abnormalities such as tuberous breast deformity, and to correct breast asymmetry. [21] [22] Saline breast implants are also used in reconstructive surgery post-mastectomy.

Eyes

Eye drops are saline-containing drops used on the eye. Depending on the condition being treated, they may contain steroids, antihistamines, sympathomimetics, beta receptor blockers, parasympathomimetics, parasympatholytics, prostaglandins, non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics or topical anesthetics. Eye drops sometimes do not have medications in them and are only lubricating and tear-replacing solutions.

Nose

There is tentative evidence that saline nasal irrigation may help with long term cases of rhinosinusitis. [23] Evidence for use in cases of rhinosinusitis of short duration is unclear. [24]

Scleral tattooing

Saline is used in scleral tattooing, coloring the white part of the human eye. [25]

Tattoo lightening

Saline is used to lighten tattoos (including microblading tattoos) through the process of osmosis. [26]

Other concentrations

Concentrations lower and higher than normal also exist. High concentrations are used rarely in medicine but frequently in molecular biology.

Hypertonic saline

Vial of 23.4% sodium chloride 23.4%25 Sodium Chloride.jpg
Vial of 23.4% sodium chloride

Hypertonic saline—7% NaCl solutions are considered mucoactive agents and thus are used to hydrate thick secretions (mucus) in order to make it easier to cough up and out (expectorate). 3% hypertonic saline solutions are also used in critical care settings, acutely increased intracranial pressure, or severe hyponatremia. [27] Inhalation of hypertonic saline has also been shown to help in other respiratory problems, specifically bronchiolitis. [28] Hypertonic saline is currently recommended by the Cystic Fibrosis Foundation as a primary part of a cystic fibrosis treatment regimen. [29]

An 11% solution of xylitol with 0.65% saline stimulates the washing of the nasopharynx and has an effect on the nasal pathogenic bacteria. This has been used in complementary and alternative medicine. [30]

Hypertonic saline may be used in perioperative fluid management protocols to reduce excessive intravenous fluid infusions and lessen pulmonary complications. [31] Hypertonic saline is used in treating hyponatremia and cerebral edema. Rapid correction of hyponatremia via hypertonic saline, or via any saline infusion > 40 mmol/L (Na+ having a valence of 1, 40 mmol/L = 40 mEq/L) greatly increases risk of central pontine myelinolysis (CPM), and so requires constant monitoring of the person's response. Water privation combined with diuretic block does not produce as much risk of CPM as saline administration does; however, it does not correct hyponatremia as rapidly as administration of hypertonic saline does. Due to hypertonicity, administration may result in phlebitis and tissue necrosis. As such, concentrations greater than 3% NaCl should normally be administered via a central venous catheter, also known as a 'central line'. Such hypertonic saline is normally available in two strengths, the former of which is more commonly administered:

Hypertonic NaCl solutions that are less commonly used are 7% (1200 mEq/L) and 23.4% (approx 4000 mEq/L), both of which are used (also via central line), often in conjunction with supplementary diuretics, in the treatment of traumatic brain injury. [32]

Less concentrated solutions

Other concentrations commonly used include:

Solutions with added ingredients

In medicine, common types of salines include:

And in cell biology, in addition to the above the following are used:

History

Saline was believed to have originated during the Indian Blue cholera pandemic that swept across Europe in 1831. William Brooke O'Shaughnessy, a recent graduate of Edinburgh Medical School, proposed in an article to medical journal The Lancet to inject people infected with cholera with highly oxygenated salts to treat the "universal stagnation of the venous system and rapid cessation of arterialisation of the blood" seen in people with severely dehydrated cholera. [33] He found his treatment harmless in dogs, and his proposal was soon adopted by the physician Thomas Latta in treating people with cholera to beneficial effect. In the following decades, variations and alternatives to Latta's solution were tested and used in treating people with cholera. These solutions contained a range of concentrations of sodium, chloride, potassium, carbonate, phosphate, and hydroxide.

The breakthrough in achieving physiological concentrations was accomplished by Sydney Ringer in the early 1880s, [34] when he determined the optimal salt concentrations to maintain the contractility of frog heart muscle tissue. Normal saline is considered a descendant of the pre-Ringer solutions, as Ringer's findings were not adopted and widely used until decades later. The term "normal saline" itself appears to have little historical basis, except for studies done in 1882–83 by Dutch physiologist Hartog Jacob Hamburger; these in vitro studies of red cell lysis suggested incorrectly that 0.9% was the concentration of salt in human blood (rather than 0.6%, the true concentration). [35]

Normal saline has become widely used in modern medicine, but due to the mismatch with real blood, other solutions have proved better. The 2018 publication of a randomized, controlled trial with 15,000 people in intensive care units showed that compared to normal saline, lactated Ringer's solution reduced the combined risk of mortality, need for additional dialysis, or persistent kidney problems from 15% to 14%, which given the large number of patients is a significant reduction. [36]

Society and culture

Coconut water has been used in place of normal saline in areas without access to normal saline. [37] Its use, however, has not been well studied. [37]

Related Research Articles

The term chloride refers to a compound or molecule that contains either a chlorine ion, which is a negatively charged chlorine atom, or a non-charged chlorine atom covalently bonded to the rest of the molecule by a single bond. Many inorganic chlorides are salts. Many organic compounds are chlorides. The pronunciation of the word "chloride" is.

<span class="mw-page-title-main">Sodium chloride</span> Chemical compound with formula NaCl

Sodium chloride, commonly known as edible salt, is an ionic compound with the chemical formula NaCl, representing a 1:1 ratio of sodium and chlorine ions. It is transparent or translucent, brittle, hygroscopic, and occurs as the mineral halite. In its edible form, it is commonly used as a condiment and food preservative. Large quantities of sodium chloride are used in many industrial processes, and it is a major source of sodium and chlorine compounds used as feedstocks for further chemical syntheses. Another major application of sodium chloride is deicing of roadways in sub-freezing weather.

Hyponatremia or hyponatraemia is a low concentration of sodium in the blood. It is generally defined as a sodium concentration of less than 135 mmol/L (135 mEq/L), with severe hyponatremia being below 120 mEq/L. Symptoms can be absent, mild or severe. Mild symptoms include a decreased ability to think, headaches, nausea, and poor balance. Severe symptoms include confusion, seizures, and coma; death can ensue.

<span class="mw-page-title-main">Electrolyte imbalance</span> Abnormality in the concentration of electrolytes in the body

Electrolyte imbalance, or water-electrolyte imbalance, is an abnormality in the concentration of electrolytes in the body. Electrolytes play a vital role in maintaining homeostasis in the body. They help to regulate heart and neurological function, fluid balance, oxygen delivery, acid–base balance and much more. Electrolyte imbalances can develop by consuming too little or too much electrolyte as well as excreting too little or too much electrolyte. Examples of electrolytes include calcium, chloride, magnesium, phosphate, potassium, and sodium.

Hypernatremia, also spelled hypernatraemia, is a high concentration of sodium in the blood. Early symptoms may include a strong feeling of thirst, weakness, nausea, and loss of appetite. Severe symptoms include confusion, muscle twitching, and bleeding in or around the brain. Normal serum sodium levels are 135–145 mmol/L. Hypernatremia is generally defined as a serum sodium level of more than 145 mmol/L. Severe symptoms typically only occur when levels are above 160 mmol/L.

The syndrome of inappropriate antidiuretic hormone secretion (SIADH), also known as the syndrome of inappropriate antidiuresis (SIAD), is characterized by a physiologically inappropriate release of antidiuretic hormone (ADH) either from the posterior pituitary gland, or an abnormal non-pituitary source. Unsuppressed ADH causes a physiologically inappropriate increase in solute-free water being reabsorbed by the tubules of the kidney to the venous circulation leading to hypotonic hyponatremia.

Hyperchloremia is an electrolyte disturbance in which there is an elevated level of chloride ions in the blood. The normal serum range for chloride is 96 to 106 mEq/L, therefore chloride levels at or above 110 mEq/L usually indicate kidney dysfunction as it is a regulator of chloride concentration. As of now there are no specific symptoms of hyperchloremia; however, it can be influenced by multiple abnormalities that cause a loss of electrolyte-free fluid, loss of hypotonic fluid, or increased administration of sodium chloride. These abnormalities are caused by diarrhea, vomiting, increased sodium chloride intake, renal dysfunction, diuretic use, and diabetes. Hyperchloremia should not be mistaken for hyperchloremic metabolic acidosis as hyperchloremic metabolic acidosis is characterized by two major changes: a decrease in blood pH and bicarbonate levels, as well as an increase in blood chloride levels. Instead those with hyperchloremic metabolic acidosis are usually predisposed to hyperchloremia.

<span class="mw-page-title-main">Nasal spray</span> Spray that delivers medications locally in the nasal cavities or systemically

Nasal sprays are used to deliver medications locally in the nasal cavities or systemically. They are used locally for conditions such as nasal congestion and allergic rhinitis. In some situations, the nasal delivery route is preferred for systemic therapy because it provides an agreeable alternative to injection or pills. Substances can be assimilated extremely quickly and directly through the nose. Many pharmaceutical drugs exist as nasal sprays for systemic administration. Other applications include hormone replacement therapy, treatment of Alzheimer's disease and Parkinson's disease. Nasal sprays are seen as a more efficient way of transporting drugs with potential use in crossing the blood–brain barrier.

<span class="mw-page-title-main">Oral rehydration therapy</span> Type of fluid replacement used to prevent and treat dehydration

Oral rehydration therapy (ORT) is a type of fluid replacement used to prevent and treat dehydration, especially due to diarrhea. It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium. Oral rehydration therapy can also be given by a nasogastric tube. Therapy can include the use of zinc supplements to reduce the duration of diarrhea in infants and children under the age of 5. Use of oral rehydration therapy has been estimated to decrease the risk of death from diarrhea by up to 93%.

<span class="mw-page-title-main">Ringer's lactate solution</span> Fluid used for resuscitation after blood loss

Ringer's lactate solution (RL), also known as sodium lactate solution,Lactated Ringer's (LR), and Hartmann's solution, is a mixture of sodium chloride, sodium lactate, potassium chloride, and calcium chloride in water. It is used for replacing fluids and electrolytes in those who have low blood volume or low blood pressure. It may also be used to treat metabolic acidosis and to wash the eye following a chemical burn. It is given by intravenous infusion or applied to the affected area.

The anion gap is a value calculated from the results of multiple individual medical lab tests. It may be reported with the results of an electrolyte panel, which is often performed as part of a comprehensive metabolic panel.

<span class="mw-page-title-main">Tonicity</span> Measure of water potential across a semi-permeable cell membrane

In chemical biology, tonicity is a measure of the effective osmotic pressure gradient; the water potential of two solutions separated by a partially-permeable cell membrane. Tonicity depends on the relative concentration of selective membrane-impermeable solutes across a cell membrane which determine the direction and extent of osmotic flux. It is commonly used when describing the swelling-versus-shrinking response of cells immersed in an external solution.

<span class="mw-page-title-main">Osmotic concentration</span> Molarity of osmotically active particles

Osmotic concentration, formerly known as osmolarity, is the measure of solute concentration, defined as the number of osmoles (Osm) of solute per litre (L) of solution. The osmolarity of a solution is usually expressed as Osm/L, in the same way that the molarity of a solution is expressed as "M". Whereas molarity measures the number of moles of solute per unit volume of solution, osmolarity measures the number of osmoles of solute particles per unit volume of solution. This value allows the measurement of the osmotic pressure of a solution and the determination of how the solvent will diffuse across a semipermeable membrane (osmosis) separating two solutions of different osmotic concentration.

<span class="mw-page-title-main">Osmotherapy</span> Medical treatment for cerebral edema

Osmotherapy is the use of osmotically active substances to reduce the volume of intracranial contents. Osmotherapy serves as the primary medical treatment for cerebral edema. The primary purpose of osmotherapy is to improve elasticity and decrease intracranial volume by removing free water, accumulated as a result of cerebral edema, from brain's extracellular and intracellular space into vascular compartment by creating an osmotic gradient between the blood and brain. Normal serum osmolality ranges from 280 to 290 mOsm/kg and serum osmolality to cause water removal from brain without much side effects ranges from 300 to 320 mOsm/kg. Usually, 90 mL of space is created in the intracranial vault by 1.6% reduction in brain water content. Osmotherapy has cerebral dehydrating effects. The main goal of osmotherapy is to decrease intracranial pressure (ICP) by shifting excess fluid from brain. This is accomplished by intravenous administration of osmotic agents which increase serum osmolality in order to shift excess fluid from intracellular or extracellular space of the brain to intravascular compartment. The resulting brain shrinkage effectively reduces intracranial volume and decreases ICP.

<span class="mw-page-title-main">Salt gland</span> Organ for excreting excess salt

The salt gland is an organ for excreting excess salts. It is found in the cartilaginous fishes subclass elasmobranchii, seabirds, and some reptiles. Salt glands can be found in the rectum of sharks. Birds and reptiles have salt glands located in or on the skull, usually in the eyes, nose, or mouth. These glands are lobed containing many secretory tubules which radiate outward from the excretory canal at the center. Secretory tubules are lined with a single layer of epithelial cells. The diameter and length of these glands vary depending on the salt uptake of the species.

A volume expander is a type of intravenous therapy that has the function of providing volume for the circulatory system. It may be used for fluid replacement or during surgery to prevent nausea and vomiting after surgery.

<span class="mw-page-title-main">Sodium in biology</span> Use of sodium by organisms

Sodium ions are necessary in small amounts for some types of plants, but sodium as a nutrient is more generally needed in larger amounts by animals, due to their use of it for generation of nerve impulses and for maintenance of electrolyte balance and fluid balance. In animals, sodium ions are necessary for the aforementioned functions and for heart activity and certain metabolic functions. The health effects of salt reflect what happens when the body has too much or too little sodium. Characteristic concentrations of sodium in model organisms are: 10 mM in E. coli, 30 mM in budding yeast, 10 mM in mammalian cell and 100 mM in blood plasma.

<span class="mw-page-title-main">Ringer's solution</span> Electrolyte solution for use in healthcare

Ringer's solution is a solution of several salts dissolved in water for the purpose of creating an isotonic solution relative to the body fluids of an animal. Ringer's solution typically contains sodium chloride, potassium chloride, calcium chloride and sodium bicarbonate, with the last used to balance the pH. Other additions can include chemical fuel sources for cells, including ATP and dextrose, as well as antibiotics and antifungals.

A balanced salt solution (BSS) is a solution made to a physiological pH and isotonic salt concentration. Solutions most commonly include sodium, potassium, calcium, magnesium, and chloride. Balanced salt solutions are used for washing tissues and cells and are usually combined with other agents to treat the tissues and cells. They provide the cells with water and inorganic ions, while maintaining a physiological pH and osmotic pressure.

<span class="mw-page-title-main">Intravenous sugar solution</span> Dextrose solution used to treat low blood sugar

Intravenous sugar solution, also known as dextrose solution, is a mixture of dextrose (glucose) and water. It is used to treat low blood sugar or water loss without electrolyte loss. Water loss without electrolyte loss may occur in fever, hyperthyroidism, high blood calcium, or diabetes insipidus. It is also used in the treatment of high blood potassium, diabetic ketoacidosis, and as part of parenteral nutrition. It is given by injection into a vein.

References

  1. 1 2 3 4 "Sodium Chloride Injection - FDA prescribing information, side effects and uses". www.drugs.com. Archived from the original on 18 January 2017. Retrieved 14 January 2017.
  2. 1 2 3 4 British national formulary : BNF 69 (69th ed.). British Medical Association. 2015. pp. 683, 770. ISBN   9780857111562.
  3. ↑ Marini JJ, Wheeler AP (2010). Critical Care Medicine: The Essentials. Lippincott Williams & Wilkins. p. 54. ISBN   9780781798396. Archived from the original on 18 September 2017.
  4. ↑ "Hypertonic Saline - FDA prescribing information, side effects and uses". www.drugs.com. Archived from the original on 18 January 2017. Retrieved 14 January 2017.
  5. ↑ Pestana C (2000). Fluids and Electrolytes in the Surgical Patient. Lippincott Williams & Wilkins. p. 11. ISBN   9780781724258. Archived from the original on 18 September 2017.
  6. ↑ Reddi BA (2013). "Why is saline so acidic (and does it really matter?)". International Journal of Medical Sciences. 10 (6): 747–750. doi:10.7150/ijms.5868. PMC   3638298 . PMID   23630439.
  7. ↑ Bozzetti F, Staun M, van Gossum A (2014). Home Parenteral Nutrition (2nd ed.). CABI. p. 4. ISBN   9781780643113. Archived from the original on 18 September 2017.
  8. ↑ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl: 10665/325771 . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  9. ↑ "The Top 300 of 2020". ClinCalc. Retrieved 7 October 2022.
  10. ↑ "Sodium Salts - Drug Usage Statistics". ClinCalc. Retrieved 7 October 2022.
  11. ↑ Prough DS, Bidani A (May 1999). "Hyperchloremic metabolic acidosis is a predictable consequence of intraoperative infusion of 0.9% saline". Anesthesiology. 90 (5): 1247–1249. doi: 10.1097/00000542-199905000-00003 . PMID   10319767.
  12. ↑ "Fluid Density Calculator". Earthwardconsulting.com. Archived from the original on 16 September 2009. Retrieved 27 February 2011.
  13. ↑ "Water Density Calculator". Csgnetwork.com. Archived from the original on 22 January 2010. Retrieved 27 February 2011.
  14. ↑ Lote CJ. Principles of Renal Physiology, 5th edition. Springer. p. 6.
  15. ↑ Hamer WJ, Wu YC (1 October 1972). "Osmotic Coefficients and Mean Activity Coefficients of Uni-univalent Electrolytes in Water at 25°C". Journal of Physical and Chemical Reference Data. 1 (4): 1047–1100. Bibcode:1972JPCRD...1.1047H. doi:10.1063/1.3253108.
  16. ↑ Brown A (20 August 2018). Ford S (ed.). "When is wound cleansing necessary and what solution should be used?". Nursing Times . Vol. 114, no. 9. Metropolis International. pp. 42–45. Retrieved 26 December 2020.
  17. ↑ "Cure a cold: Saline Nasal drops". Archived from the original on 16 January 2013.
  18. ↑ "Blocked Nose in Babies ('Snuffles')". Patient UK .
  19. ↑ "Tixylix saline nasal drops". Netdoctor. 30 March 2011. Archived from the original on 1 November 2012.
  20. ↑ "Sinus Rinsing For Health or Religious Practice". CDC. 28 February 2017.
  21. ↑ Eisenberg T (October 2021). "Does Overfilling Smooth Inflatable Saline-Filled Breast Implants Decrease the Deflation Rate? Experience with 4761 Augmentation Mammaplasty Patients". Aesthetic Plastic Surgery. 45 (5): 1991–1999. doi: 10.1007/s00266-021-02198-3 . PMC   8481168 . PMID   33712871.
  22. ↑ Eisenberg T (2019). "One-Stage Correction of Tuberous Breast Deformity Using Saline Implants: Without the Need for Radial Scoring or Lowering the Inframammary Fold". American Journal of Cosmetic Surgery. 36 (4): 191–196. doi:10.1177/0748806819841466. S2CID   145932734.
  23. ↑ Succar EF, Turner JH, Chandra RK (May 2019). "Nasal saline irrigation: a clinical update". International Forum of Allergy & Rhinology. 9 (S1): S4–S8. doi: 10.1002/alr.22330 . PMID   31087631.
  24. ↑ Achilles N, Mösges R (April 2013). "Nasal saline irrigations for the symptoms of acute and chronic rhinosinusitis". Current Allergy and Asthma Reports. 13 (2): 229–235. doi:10.1007/s11882-013-0339-y. PMID   23354530. S2CID   9798807.
  25. ↑ "A Model Almost Lost Her Eye After Getting a Sclera Tattoo. Here's Why She Did It". TIME. 29 September 2017. Retrieved 28 April 2024. It happens when a mixture of ink and saline is injected into the eye through a small needle.
  26. ↑ Dall'Asen N (18 February 2022). "OK, I'll Say It: I Regret Getting My Eyebrows Microbladed". Allure. Retrieved 28 April 2024.
  27. ↑ Reeves EP, Williamson M, O'Neill SJ, Greally P, McElvaney NG (June 2011). "Nebulized hypertonic saline decreases IL-8 in sputum of patients with cystic fibrosis". American Journal of Respiratory and Critical Care Medicine. 183 (11): 1517–1523. doi:10.1164/rccm.201101-0072OC. PMID   21330456.
  28. ↑ Principi T, Komar L (2011). "A critical review of "a randomized trial of nebulized 3% hypertonic saline with epinephrine in the treatment of acute bronchiolitis in the emergency department."". Journal of Population Therapeutics and Clinical Pharmacology = Journal de la Therapeutique des Populations et de la Pharmacologie Clinique. 18 (2): e273–e274. PMID   21633141.
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  32. ↑ Mortimer DS, Jancik J (June 2006). "Administering hypertonic saline to patients with severe traumatic brain injury". The Journal of Neuroscience Nursing. 38 (3): 142–6. doi:10.1097/01376517-200606000-00002. PMID   16817665. Archived from the original on 19 November 2010 – via Medscape.
  33. ↑ O'Shaugnessy WB (1831). "Proposal for a new method of treating the blue epidemic cholera by the injection of highly-oxygenated salts into the venous system". Lancet. 17 (432): 366–71. doi:10.1016/S0140-6736(02)94163-2.
  34. ↑ Sutin KM, Marino PL (2007). The ICU book. Lippincott Williams & Wilkins. ISBN   978-0-7817-4802-5.
  35. ↑ Awad S, Allison SP, Lobo DN (April 2008). "The history of 0.9% saline". Clinical Nutrition. 27 (2): 179–188. doi:10.1016/j.clnu.2008.01.008. PMID   18313809.
  36. ↑ Dalton C (31 March 2018). "Why Did Sterile Salt Water Become The IV Fluid Of Choice?". NPR.org.
  37. 1 2 Campbell-Falck D, Thomas T, Falck TM, Tutuo N, Clem K (January 2000). "The intravenous use of coconut water". The American Journal of Emergency Medicine. 18 (1): 108–111. doi:10.1016/s0735-6757(00)90062-7. PMID   10674546.
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