Why Lactated Ringers in Postpartum?

[BKnurse44]

I just started working on a postpartum floor as a new grad and I was wondering why the main iv solution used is Lactated Ringers instead of Normal saline?

Thanks

[GilaRRT]

Oh, better volume expander than NS, for hypotension.

How did you come to this conclusion?

[NurseNora, BSN, RN]

My guess is that it's physician preference, as a previous poster suggested. We use NSS or LR when we run Pit because it can cause water intoxication (related to antidiuretic hormone and can cause fluid retention), so we need a solution with some electrolytes in it to lessen the chances of intoxication. In my experience, most places don't run D5LR in labor because if you have to give an immediate bolus, you don't want to use a glucose solution (makes the baby sweet, pumps out lots of insulin, if born shortly thereafter, sugar levels drop and you've got a sick baby). For convenience sake, most docs just order a mainline of the same fluid as the Pit and continue the same for any IVs needed post partum.

Ask one of your docs why they use one rather than the other. If they aren't pressed for time, most of them enjoy teaching and you look good by asking questions to increase your knowledge. I know I'm going to ask some of my docs.

[Esme12, ASN, BSN, RN]

all these points are good but it is mostly because, as someone mentioned the storage of lactate that is matabolized by the liver to bicarbonate therefore assisting with acid-base balance

http://www.associatepublisher.com/e/i/in/intravenous_therapy.htm

[Hushi05]

With NS there is a greater risk of water intoxication with the use of pitocin than with LR.

[GilaRRT]

With NS there is a greater risk of water intoxication with the use of pitocin than with LR.

Could you explain the physiology of this statement?

[redwatch218]

Lactated Ringer's is preferred because Normal saline has the potential for hyperchloremic acidosis. lactated ringer's also has electrolytes in it to replace the ones that may be lost from normal blood loss during pregnancy or from hemorrhage. from my instructor. we are doing a rotation at a maternity unit this semester.

[offlabel]

In major trauma patients LR is used so that the liver can store the lactate for later use in maintaining acid base balance. The drawback is that you can't give blood with LR because the K will lyse RBC's.

Not true. If the small amount of potassium in LR lysed PRBC's, they'd lyse in the bag because there is far more potassium in a unit of packed cells than there is in a bag of ringers.

The concern was that the calcium in the LR would react with the preservative in the prbc's and cause cell clumping, but that's not even true. Giving prbc's thru an LR line will not cause a sufficient mixing of the calcium with blood preservative to be a problem. It will upset a lot of people that don't know the facts, though.

[OBwonKnewbie]

Not true. If the small amount of potassium in LR lysed PRBC's, they'd lyse in the bag because there is far more potassium in a unit of packed cells than there is in a bag of ringers.

The concern was that the calcium in the LR would react with the preservative in the prbc's and cause cell clumping, but that's not even true. Giving prbc's thru an LR line will not cause a sufficient mixing of the calcium with blood preservative to be a problem. It will upset a lot of people that don't know the facts, though.

I am just curious. .....what is the reason then that you can't hang blood with LR?

[offlabel]

I am just curious. .....what is the reason then that you can't hang blood with LR?

You can.... as long as you don't mix a significant volume of it with the packed cells. The miniscule amount of calcium in the LR in the IV tubing is not nearly enough to cause the reaction with the blood preservative to cause cell clumping.

[offlabel]

With NS there is a greater risk of water intoxication with the use of pitocin than with LR.

You might be thinking of D5W or D5.5 NS? There is no free water release from NS nor LR.

[offlabel]

If your talking about 1 to 2 liters, there really isn't any difference between those two. Beyond that, you're right. LR is probably better. But better than both of those for larger crystalloid volumes is Plasmalyte or Normosol.

[cayenne06, MSN, CNM]

Better than LR or NS is to let moms drink freely and cap those heplocks unless there's a need for fluid. Sorry, off topic but I couldn't resist, especially since there are students reading More and more hospitals are already dropping or loosening their NPO restrictions on laboring women, but it is still annoyingly pervasive.

As far as LR vs NS, it's been pretty much covered in the thread. I'll just add that there is little hard data to say a certain type of IVF improves outcomes in L&D, and the data we do have actually seems to supports a little added dextrose in that IVF, which I have not seen used routinely in the hospitals I have worked in- the only time we used it at the last hospital I worked in was for post op.

And while LR is standard in many (most?) units, I've never seen any hesitation to switch to NS when the stock is low.