Special Warning : אזהרת שימוש

WARNINGS
Hypersensitivity/infusion reactions, including hypotension, pyrexia, tremor, chills, urticaria, rash, and pruritus may occur with 0.45% Sodium Chloride Injection.
Stop the infusion immediately if signs or symptoms of a hypersensitivity reaction develop, such as tachycardia, chest pain, dyspnea and flushing. Appropriate therapeutic countermeasures must be instituted as clinically indicated.

Depending on the volume and rate of infusion, the intravenous administration, 0.45% Sodium Chloride Injection can cause fluid and/or solute overloading resulting in dilution of serum electrolyte concentrations, over-hydration/hypervolemia, congested states, pulmonary edema, or acid-base imbalance. The risk of dilutive states is inversely proportional to the electrolyte concentration of the injection. The risk of solute overload causing congested states with peripheral and pulmonary edema is directly proportional to the electrolyte concentrations of the injection.

Monitor changes in fluid balance, electrolyte concentrations, and acid base balance during prolonged parenteral therapy or whenever the condition of the patient or the rate of administration warrants such evaluation.

The infusion of solutions with 0.45% Sodium Chloride Injection may result in hyponatremia. Close clinical monitoring may be warranted. Hyponatremia can lead to headache, nausea, seizures, lethargy, coma, cerebral edema and death. The risk for hyponatremia is increased, for example, in children, elderly, women, postoperatively, in persons with psychogenic polydipsia, and in patients treated with medications that increase the risk of hyponatremia (such as certain antiepileptic and psychotropic medications). The risk for developing hyponatremic encephalopathy is increased, for example, in pediatric patients (<16 years of age), women (in particular pre-menopausal women), in patients with hypoxemia, and in patients with underlying central nervous system disease. Acute symptomatic hyponatremic encephalopathy is considered a medical emergency.

Administer of 0.45% Sodium Chloride Injection, with particular caution to patients with or at risk for hypervolemia or with conditions that may cause sodium retention, fluid overload and edema; such as patients with primary hyperaldosteronism, or secondary hyperaldosteronism [e.g., associated with hypertension, congestive heart failure, liver disease (including cirrhosis), renal disease (including renal artery stenosis, nephrosclerosis) or pre-eclampsia]. Certain medications may increase risk of sodium and fluid retention, see DRUG INTERACTIONS.

ADMINISTER of 0.45% Sodium Chloride Injection with particular caution to patients with severe renal impairment. In such patients, administration of Sodium Chloride Injection, may result in sodium retention.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product.
Any suspected adverse events should be reported to the Ministry of Health according to the National Regulation by using an online form http://forms.gov.il/globaldata/getsequence/getsequence.aspx?formType=AdversEffectMedic@moh.gov.il       PRECAUTIONS
General
Do not connect flexible plastic containers in series in order to avoid air embolism due to possible residual air contained in the primary container. Such use could result in air embolism due to residual air being drawn from one container before administration of the fluid from a secondary container is completed.

Pressurizing intravenous solutions contained in flexible plastic containers to increase flow rates can result in air embolism if the residual air in the container is not fully evacuated prior to administration.

Use of a vented intravenous administration set with the vent in the open position could result in air embolism. Vented intravenous administration sets with the vent in the open position should not be used with flexible plastic containers.

Do not mix or administer 0.45% Sodium Chloride Injection through the same administration set with whole blood or cellular blood components.
Rapid correction of hypo- and hypernatremia is potentially dangerous (risk of serious neurologic complications). Dosage, rate, and duration of administration should be determined by a physician experienced in intravenous fluid therapy.

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