# Normal saline (0.9% sodium chloride)

Fluid resuscitation, pediatric bolus limits, and nebulized saline are different uses.

Population: Adult & pediatric guidance. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources..
Canonical page: https://www.ocmedic.com/guides/normal-saline/
Official source: [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Check before giving

- Reassess lung sounds and perfusion before more fluid. Avoid transferring sepsis fluid instructions into cardiogenic pulmonary edema.
- PR-205 directs immediate base contact without fluids for pediatric cardiogenic shock with pulmonary edema.

## Source documents

- [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=5)
- [I-20 — Pediatric Medication Volume Dose by Weight](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf)
- [SO-M-055 — Suspected Sepsis](https://www.ochealthinfo.com/sites/healthcare/files/2024-10/SO-M-55%20Sepsis%209-2024.pdf)
- [SO-T-005 — General Injury and Trauma - Adult / Adolescent](https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-T-05%20Gen%20Trauma%204-2024_0.pdf)
- [SO-P-080 — Shock (Symptomatic Hypotension) - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2025-05/SO-P-80%20Shock%205-2025.pdf)
- [SO-P-035 — Acute Respiratory Distress - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-P-35%20Respiratory%2010-2025.pdf)
- [PR-205 — Preparation and Dosing of Push Dose Epinephrine - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2024-10/PR-205%20Peds%20Push%20Dose%20Epi%209-2024.pdf)

## Use in OCEMS

- Used in multiple poor-perfusion/hypovolemia pathways and as a diluent or flush where a procedure specifies it.
- Do not apply a universal fluid limit to every condition: hemorrhage/TBI, sepsis, cardiac, and pediatric pathways have different instructions.

## Adult / adolescent

| Indication / route | Dose & limits |
| --- | --- |
| Common medical resuscitation pattern | 250 mL IV boluses, reassessing between doses, up to 1 L in the relevant medical standing order. Observe any clear-lung/no-CHF condition. |
| Traumatic hemorrhage / TBI | SO-T-005 gives separate ongoing-infusion and BP targets. Use that condition-specific pathway rather than assuming a universal 1 L ceiling. |

## Pediatric

- Many pediatric orders specify 20 mL/kg IV/IO, maximum 250 mL per bolus, and base contact; up to 3 total boluses under the applicable standing order.
- SO-P-080: if pressure does not improve after the first bolus, continue indicated fluid resuscitation and request a pediatric push-dose epinephrine order.
- Croup-like barking cough in SO-P-035: 3 mL normal saline by continuous nebulization as tolerated. This is an inhalation dose, not a fluid-resuscitation dose.

## Pediatric weight table — Poor perfusion / hypotension bolus

- Source: SO-P-080. Dose rule: 20 mL/kg; route: IV/IO.
- 20 mL/kg IV/IO, maximum 250 mL per bolus. SO-P-080 permits two repeats for three total boluses, with reassessment.
- Make base contact. If BP does not improve after the first bolus, request the pediatric push-dose epinephrine order while continuing indicated fluid resuscitation.
- This table is for the SO-P-080 shock bolus. Other indications have their own limits; PR-205 directs no fluid bolus when cardiogenic shock presents with pulmonary edema.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
| Exact weight | Dose — IV/IO |
| --- | --- |
| 3 kg | 60 mL |
| 4 kg | 80 mL |
| 5 kg | 100 mL |
| 6 kg | 120 mL |
| 8 kg | 160 mL |
| 10 kg | 200 mL |
| 12 kg | 240 mL |
| 15 kg | 250 mL |
| 20 kg | 250 mL |
| 25 kg | 250 mL |
| 30 kg | 250 mL |
| 35 kg | 250 mL |
| 40 kg | 250 mL |
| 45 kg | 250 mL |
| 50 kg | 250 mL |
| 60 kg | 250 mL |

## Preparation & reassessment

- Verify IV versus preservative-free nebulizer product and the intended route.
- Record each bolus volume, cumulative volume, BP, respiratory findings, and response. Use the specific pediatric order for maximums and repeat count.