liver failure and LR

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does anyone know of any contraindications for giving LR to a pt in liver failure ? i vaguely remember something on the CCRN review tapes about it but cannot recall it to save my (or my pt's) life. i think it has something to do w/ how it is metabolized and the byproducts of that metabolism, ie. ammonia or something .... can anyone help me ???

mittels....

1) there is no glucose in LR

2) there are 4mEq of K per liter of LR

3) potassium does not get metabolized --- what would the breakdown product be???

4) what does administering potassium have to do with metabolic acidosis???

if the patient is acidotic the patient will have a falsely elevated potassium due to the extracellular shift of potassium - so let's say the patient has a K=6.5 due the acid/base imbalance, can you please explain to me how diluting their blood with one liter of fluid containing 4 mEq of potassium is going to raise their potassium??? that doesn't make sense, if anything it would dilute their potassium.... the only time i wouldn't administer LR to a patient who is hyperkalemic is when they are in acute renal failure and are unable to excrete excess potassium... however in patients who are in hepatic failure and who have renal failure (usually due to a hepato-renal syndrom), they should be on dialysis, and when a patient is on dialysis it doesn't matter what kind of fluid you administer, since the excess K is leeched off in the dialysis bath.

the only times i would not administer LR due to the concern regarding potassium content: hyperkalemia due to TRUE excess of potassium, not simply potassium shifting in or out of cells due to acid/base status.

this time i won't make a big fuss about you telling me: "critical thinking now!!!" - next time i won't be so kind :)

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Originally posted by Tenesma

mittels....

1) there is no glucose in LR

2) there are 4mEq of K per liter of LR

3) potassium does not get metabolized --- what would the breakdown product be???

4) what does administering potassium have to do with metabolic acidosis???

if the patient is acidotic the patient will have a falsely elevated potassium due to the extracellular shift of potassium - so let's say the patient has a K=6.5 due the acid/base imbalance, can you please explain to me how diluting their blood with one liter of fluid containing 4 mEq of potassium is going to raise their potassium??? that doesn't make sense, if anything it would dilute their potassium.... the only time i wouldn't administer LR to a patient who is hyperkalemic is when they are in acute renal failure and are unable to excrete excess potassium... however in patients who are in hepatic failure and who have renal failure (usually due to a hepato-renal syndrom), they should be on dialysis, and when a patient is on dialysis it doesn't matter what kind of fluid you administer, since the excess K is leeched off in the dialysis bath.

the only times i would not administer LR due to the concern regarding potassium content: hyperkalemia due to TRUE excess of potassium, not simply potassium shifting in or out of cells due to acid/base status.

this time i won't make a big fuss about you telling me: "critical thinking now!!!" - next time i won't be so kind :)

Good job with critical thinking. I am not saying to give a pt with liver failure LR. Also think about this, with live failure goes kidney failure. What happens when the kidneys cant dispose of K+. Metabolic acidosis and K+ you ask what it has to do with it. Think about it.

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Specializes in Critical Care.

Wow! Dare I ask a question about something more complex than IV fluids? Tenesma, do you teach? You should. Your answers are great.

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Tenesma has an outstanding amount of knowledge....i really enjoy the posts.

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Tenesma,

thank you for clearing that up for me. what you have said really makes more sense. if my memory serves me right, you're an MDA, right ?

to everyone else,

thank you for your posts as well. i didn't mean to get everyone's feathers all ruffled .:D

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Originally posted by mittels

Good job with critical thinking. I am not saying to give a pt with liver failure LR. Also think about this, with live failure goes kidney failure. What happens when the kidneys cant dispose of K+. Metabolic acidosis and K+ you ask what it has to do with it. Think about it.

did you bother to read tenesma's post?

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:roll :chuckle :roll

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I read a blurb the other day (have NOT done my Neuro didactic yet), that Plasmalyte and LR can be converted to glucose and thus are not the fluids of choice for Neuro pts.

Any comments??

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while you are right about glucose not being a good thing for neuro patients ... the reason why LR is not used is because of its low osmolarity (273-274) compared with normal saline (304)... that is the main reaason... however, once the mass effect issue is resolved (hematoma removed, mass removed, etc...) it doesn't really matter anymore what kind of fluid you use.

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Tenesma:

I hear differing opinions on D5, with some sources saying that the body uses up the dextrose too fast for it to be considered hyperosmolar. Your opinion?

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D5 isn't hyperosmolar it is about 250 - D10 is hyperosmolar...

while the body does consume it, the initial change in plasma osmolarity is what interferes with what you are trying to do when stabilizing an emergent neuro case or at the beginning of a neuro case

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looks like this post has died. i want to thank everyone for their insight and expertise in this area. :D

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