Lactated Ringers VS 0.9% Saline

[Bmg609]

I am doing a case study with a patient who has a fluid volume deficit and I am unsure if would administer regular saline or lactated ringers. The information given is that the patient was working on a farm outside and has very little to drink. He feels fatigued and doesn't eat lunch or dinner choosing to sleep instead and so he hasn't eaten all day. He wakes up the next day with swollen hands and feet, a headache, and dizziness and goes to the hospital. I am unsure if his electrolytes would be depleted enough to necessitate the use of LR. Any thoughts?

[nynursey_]

Does he have a prior cardiac history? Have they drawn lab values to ascertain whether or not he has electrolyte changes r/t FVD?

[Bmg609]

The case study doesn't give any of that information.

[nynursey_]

The case study doesn't give any of that information.

Is it asking you to make a personal choice based upon general knowledge of FVD? Because typically a physician would make that call. And you would also have some lab values to back up your suspicion of FVD, so you'd have an idea if you were dealing with dehydration with hyponatremia, or an overall FVD …

I'm confused as to what the study wants you to determine.

[Bmg609]

The exact question is: What IV solution would the nurse anticipate to be started on Byron? They are basically asking us to make a call based on our knowledge of fluid and electrolyte balance. I wish they would give the serum blood levels of the electrolytes because it would make the decision much simpler. I am just not sure if the one day of no eating and working hard is enough to deplete his electrolytes to a level that would require the use of LR.

[nynursey_]

The exact question is: What IV solution would the nurse anticipate to be started on Byron? They are basically asking us to make a call based on our knowledge of fluid and electrolyte balance. I wish they would give the serum blood levels of the electrolytes because it would make the decision much simpler. I am just not sure if the one day of no eating and working hard is enough to deplete his electrolytes to a level that would require the use of LR.

Well, if he has simple isotonic dehydration, then I think a bolus of some NS would do the trick. This is, of course, after oral rehydration attempts haven't brought him back up to speed, although if he has to be hospitalized … he's probably beyond that point. I can't see LR used for a simple dehydration admission. I see LR used a lot in the OR during surgical procedures. Although, according to a study I just read, a risk of acidosis exists with the use of large volumes of NS infused quickly vs LR, sooo …

A Randomized Clinical Trial Comparing the Effect of Rapidly Infused Crystalloids on Acid-Base Status in Dehydrated Patients in the Emergency Department

I guess it really depends. Is this for school? Cross reference your text …

[nynursey_]

Here is another study examining the same concept, although these do refer to patients more in shock …

http://emjournalclub.com/uploads/Ringers_Lactate_vs._Normal_Saline_Schott_1.2010.pdf

[Bmg609]

It is for school. My text lists these two solutions as the primary fluids for resuscitation but isn't completely clear about which to use when. It does say that LR is commonly used for burn or surgical patients so I am just not sure. Thanks for your help.

[nynursey_]

It is for school. My text lists these two solutions as the primary fluids for resuscitation but isn't completely clear about which to use when. It does say that LR is commonly used for burn or surgical patients so I am just not sure. Thanks for your help.

You're welcome. I can't really help any further. Aside from providing medical advice being against the TOS, it really is physician preference in the real world. An order set for fluid resuscitation will come through for you to acknowledge and/or implement, and it will likely be up to what the physician prefers based on evidence and his prior knowledge/experience. I'm not sure if your instructor is looking for a specific answer, but it seems as though he/she is. Good luck!

[ICU56]

NS.

Because the patient has no GI issues, he needs replacement of fluid lost through sweating and insensible losses. I would use NS until labs tell me whether the patient needs anything more. Granted I would of course follow the instructions of the MD. But for school purposes that would be my answer.

[RNGriffin]

I know this can be difficult so I will help you solve it clinically.

Your patient has dehydration 2/2 to excessive heat exposure.

Your patient is at risk for shock...

what do you suspect will be seen with the labs?

There are to major components in this case study that can guide you on which to choose and it will be an obvious answer?

One given will bring on another complication, while the other will balance to volume?

Hint: knowing about shock will help you

[RNGriffin]

There is a key component in your clinical data that you are missing. The patient is losing fluid due to heat exposure from being outside.

What happens if the patient is exposed to excess heat without replenishing fluid loss via diaphoresis?---