Lactated Ringers vs .9NS

JeneraterRN · Jun 28, 2011

LR vs. NS is a common debate. By the books, LR is the closest to blood crystalloids, so many believe this to be the first choice for trauma, surgery, and OB where there is a potential for blood loss. Pay attention to your Pt's labs because LR contains electrolytes that NS does not. There are medications that are incompatible with LR, and NS is the only solution you can use for blood administration. Hopefully, this points you in the right direction. Know your components of each. Good luck on the boards!

elizanne · Jun 28, 2011

The components of each are different. 0.9%NS is NaCl, while lactated ringers has sodium ions, chloride ions, potassium ions, calcium ions, and lactate (generally as NaCl, KCl, and sodium lactate).

Anyone feel free to correct me or expand on the make up of lactated ringers--I didn't get it from my textbook, just did a quick google search.

nurseprnRN, BSN, RN · Jun 28, 2011

normal saline is just nacl in water (although for purposes of serum sodium, it neither adds nor subtracts sodium. really. i can explain some other time if anyone's interested.)

lactated ringers (or ringer's lactate) generally has about

130 meq of sodium ion = 130 mmol/l
109 meq of chloride ion = 109 mmol/l
28 meq of lactate = 28 mmol/l
4 meq of potassium ion = 4 mmol/l
3 meq of calcium ion = 1.5 mmol/l (thanks, wikipedia, for your fast response since i couldn't remember all the exact amounts)

individual manufacturers' formulations may vary a little, so it's not the same standard as ns, which is the same everywhere.

the major thing about rl is that its lactate ions are involved with acid/base metabolism. lactate being metabolized in the (normal) will buffer acidosis, but people with liver disease can't do this so it's not usually a good choice for them.

it's not a good choice for maintenance therapy, because it is pretty high in sodium and low in potassium for a maintenance that a body would have to depend on.

i would be willing to bet you won't get more than one question on it, and also that most nurses on your first job will have little clue about it, generally because it's not really used that much anymore. don't stress on it too much. ymmv.

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Jun 28, 2011

Excellent info, I'd like to add something. Actually you allready know this and don't realise it.

Think about a major trauma/burn patient. What's he or she need to do? Heal. What happens in healing? Right! Metabolism goes up, even doubles! What can't the patient do? Of course, can't eat. So where do the calories come from to feed that raging metabolism? Too easy, burn fat. But burning fat has the side effect of producing lots of ketones which are a result of, right acidosis. So, knowing that the liver stores lactate as a (one) way to regulate acid/base balance, then Lactated Ringers would be a really good fluid for burn/trauma patients, but you already knew that and didn't realise it, right?

Just remember to never give blood with anything but 0.9% NaCl.

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Jun 29, 2011

Forgive me if the preceding seems condescending. It works much better when I have chalk and blackboard at hand and am teaching Paramedics in person.

ShannonRN2010, BSN, RN · Jun 29, 2011

I work in surgery, we never give LR to renal patients. If the cre. is elevated or they are renal, we give then 0.9 NaCl.

nerdtonurse?, BSN, RN · Jun 29, 2011

Who gets LR -- a burn/trauma/surgery patient, as above mentioned, but often the LR on a surgical patient is Dc'd once they hit the floor or within 12 hours. Why? Think about this.

Who doesn't get LR -- renal and CHF patients, because their electrolytes are fried to begin with, so if you get a question about a dialysis patient, no LR. You don't want to load a dialysis patient up with something they can't pee out.

LR is contraindicated as a maintenance fluid for someone getting anything with calcium in it; also, you'd have to double check any antibiotic before you piggyback'd it into LR.

Who gets NS -- someone getting blood (with their Y tubing), standard KVO, or basic IV maintenance lines

Who doesn't get NS -- someone who's in with high serum sodium levels, or someone who has a lot of edema (they'd need half normal). Good luck!

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Jun 29, 2011

When giving meds, IV fluids, etc, etc, always remember the patient IS 70% 0.9% NaCl!

Jenni811, RN · Jun 29, 2011

Lactated is closest to blood components it contains other normally occurring electrolytes (i.e. magnesium/calcium). Most commonly used for Labor/Delivery. Where as NaCl (Hyper, hypo/iso) is used for water balance. So if someone blood pressure is low they may just need a bolus of NaCl to give them volume rather than the electrolytes.

Kinda how we were told, hope i explained that ok.

RedCell · Jun 29, 2011

Sorry, but many of these statements regurgitate perpetual nursing dogmas that once investigated are easily proven wrong. The crystalloid with the most physiological resemblance to plasma is plasmalyte not ringer's lactate. Ringer's Lactate is actually very common in the hospital setting. Normal saline is not the only crystalloid that can be given with blood. The fact is multiple solutions can be co-administered with packed cells. Plasmalyte A and LR are two that are perfectly safe. Yeah many quote the whole citrate/calcium interaction creating the proverbial clot formation. This is way overblown. Think how much calcium is in LR....2.7-3mEq/L. Will this really cause problems? Maybe if that blood sits in the tubing for six hours. Multiple studies from 1980 up till present day have concluded that this is more myth than fact. Students, do more than read your textbooks. By the time you enter your nursing program and start reading them they will already be out of date. Push your instructors to give you data to back up their claims and do your own research. The more you explore, the more myths you will uncover.