Lactated Ringer's solution

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Ringers Lactate solution is a solution that is isotonic with blood and intended for intravenous administration. It may also be given subcutaneously. Ringers Lactate solution is grouped with intravenous fluids known as "crystalloids" – which include saline and dextrose solutions (compared to the "colloids" which contain larger molecules such as starch or gelatine).

Ringers Lactate solution is abbreviated as "LR", "RL" or "LRS". It is also known as Lactated Ringers solution (although Ringer's solution technically refers only to the saline component, without lactate). It is very similar, though not identical to, Hartmann's solution, which is more commonly found in British and Irish hospitals[citation needed] and has slightly different ionic concentrations.

Medical uses[edit]

Ringers Lactate solution is often used for fluid resuscitation after a blood loss due to trauma, surgery, or a burn injury.[citation needed] It has been used to induce urine output in patients with renal failure.[citation needed]

Ringers Lactate solution is used because the by-products of lactate metabolism in the liver counteract acidosis, which is a chemical imbalance that occurs with acute fluid loss or renal failure.[1]

The IV dose of Ringers Lactate solution (LRS) is usually calculated by estimated fluid loss and presumed fluid deficit. For fluid resuscitation the usual rate of administration is 20 to 30 ml/kg body weight/hour. LRS is not suitable for maintenance therapy (i.e., maintenance fluids) because the sodium content (130 mEq/L) is considered too low, particularly for children, and the potassium content (4 mEq/L) is too low, in view of electrolyte daily requirement. Moreover, since the lactate is converted into bicarbonate longterm use will cause patients to become alkalotic.[2] Other commonly used intravenous fluids include normal saline and Hydroxyethyl starch solutions (used in hypovolemic shock). Lactated Ringer's and other crystalloids are also used as vehicles for the IV delivery of drugs. LRS is usually given intravenously.

In a large-volume resuscitation over several hours, LRS maintains a more stable blood pH as compared to isotonic saline.[3]

Physical and chemical properties[edit]

One litre of Ringers Lactate solution contains:

Ringers Lactate has an osmolarity of 273 mOsm/L.[4] The lactate is metabolized into bicarbonate by the liver, which can help correct metabolic acidosis. Though lactate itself contributes a strong anion and generates protons, Ringers Lactate solution alkalinizes via the sodium cations it leaves behind. They increase the strong ion difference in solution, leading to proton consumption and an overall alkalinizing effect. [5]

The solution is formulated to have concentrations of potassium and calcium that are similar to the ionized concentrations found in normal blood plasma. To maintain electrical neutrality, the solution has a lower level of sodium than that found in isotonic saline or plasma.[3]

Generally, the sodium, chloride, potassium and lactate come from NaCl (sodium chloride), NaC3H5O3 (sodium lactate), CaCl2 (calcium chloride), and KCl (potassium chloride).

There are slight variations for the composition for Ringer's as supplied by different manufacturers. As such, the term Ringer's lactate should not be equated with one precise formulation.[6]

Although its pH is 6.5, it is an alkalizing solution.

History[edit]

Ringer's saline solution was invented in the early 1880s by Sydney Ringer,[3] a British physician and physiologist. Ringer was studying the beating of an isolated frog heart outside of the body. He hoped to identify the substances in blood that would allow the isolated heart to beat normally for a time.[7] The use of Ringer's original solution of inorganic salts slowly became more popular.[3] In the 1930s, the original solution was further modified by American pediatrician Alexis Hartmann for the purpose of treating acidosis. Hartmann added lactate, which mitigates changes in pH by acting as a buffer for acid. Thus the solution became known as "Ringers Lactate solution" or "Hartmann's solution".[8][3]

Veterinary use[edit]

A calico receiving palliative care near the end of her life

It is used for the treatment or palliative care of chronic renal failure in small animals. The solution can be administered both by IV and subcutaneously. Administering the fluids subcutaneously allows the solution to be readily given to the animal by a trained layperson, as it is not required that a vein be located. The solution is slowly absorbed from beneath the skin into the bloodstream of the animal.[9]

See also[edit]

References[edit]

  1. ^ Lactated Ringers Package Insert information, side effects and uses
  2. ^ "LACTATED RINGERS (sodium chloride, sodium lactate, potassium chloride, and calcium chloride) injection, solution [B. Braun Medical Inc.]". HUMAN PRESCRIPTION DRUG LABEL. DailyMed. "ADVERSE REACTIONS [...] although the metabolism of lactate to bicarbonate is a relatively slow process, aggressive administration of sodium lactate may result in metabolic alkalosis. Careful monitoring of blood acid-base balance is essential during the administration of sodium lactate." 
  3. ^ a b c d e Kenneth M Sutin; Marino, Paul L. (2007). The ICU book. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-4802-X. 
  4. ^ Williams EL, Hildebrand KL, McCormick SA, Bedel MJ (May 1999). "The effect of intravenous lactated Ringer's solution versus 0.9% sodium chloride solution on serum osmolality in human volunteers". Anesth. Analg. 88 (5): 999–1003. doi:10.1213/00000539-199905000-00006. PMID 10320158. 
  5. ^ Acid-base abnormalities in the intensive care unit.
  6. ^ DailyMed Result
  7. ^ Miller, DJ (2004). "Sydney Ringer; physiological saline, calcium and the contraction of the heart". The Journal of physiology 555 (Pt 3): 585–7. doi:10.1113/jphysiol.2004.060731. PMC 1664856. PMID 14742734. 
  8. ^ White SA, Goldhill DR (May 1997). "Is Hartmann's the solution?". Anaesthesia 52 (5): 422–7. doi:10.1111/j.1365-2044.1997.090-az0082.x. PMID 9165959. 
  9. ^ Giving Subcutaneous Fluids to a Cat

8. http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=5215ec33-8cfe-4885-ae92-e6a12100bd27