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"Normal" 0.9% Salt Solution Is Neither "Normal" Nor Physiological

Khalil G. Wakim, MD
JAMA. 1970;214(9):1710. doi:10.1001/jama.1970.03180090074027.
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To the Editor.—  In clinical and experimental literature, in circulars and house organs of the pharmaceutical industry, and on the labels of containers, the terms "normal saline" and "physiological saline" are commonly applied to 0.9% solution of sodium chloride. Although in long-standing usage and not of major significance, such terminology nevertheless is incorrect and should be avoided.At the risk of elucidating the obvious, I explain why it is wrong to designate 0.9% sodium chloride solution as "normal" or "physiological."A normal chemical solution of sodium chloride contains 58.5 gm/liter while a 0.9% solution contains only 9 gm/liter. Therefore, a normal chemical solution of sodium chloride is 6 1/2 times as strong as a 0.9% solution. Since a 0.9% solution is isotonic and isosmotic with body fluids, a normal chemical solution (5.85%) therefore is obviously damagingly hypertonic.When blood or other cells from tissues are placed in noninjurious aqueous solutions


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