LR as maintenance

[MarcosB]

I was wondering what the dangers would be for LR running as maintenance? I only ever really see LR ordered when we have a post-op surgery kid, but i've never ran LR for long periods of time. We recently had an incident were LR was ran at x2 maintenance on an infant that was NPO for 12hrs. The baby became lethargic and POC glucose was 30. I just graduated recently and was trying to look up some information on the rationale why this would happen.

[LadyFree28, BSN, LPN, RN]

A FW points:

Remember fluids and solutions. What types of solutions are similar to our blood?

Also, why was the solution running so high??? What was the rationale??? Was it calculated during assessment and alerted if it was too high?

What other interventions were needed to assess and monitor the pt? What was their PMHx that could've been at risk and should've been monitored for?

I think you may have answered you question...the maintenance dose was 2x...that alone may have produced the same symptoms, and potential complications, along with the pt's diagnosis, PMHx, not just the fluids alone.

[Double-Helix, BSN, RN]

One litre of lactated Ringer's solution contains:

• 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
  

The problem is that an infant with very little glycogen reserve was receiving a maintenance fluid with no dextrose at twice his fluid requirement for over 12 hours. Somebody dropped the ball.

I've never seen LR used as a maintenance fluid in my PICU. We almost always use D5 1/2 NS or D5 0.2 NS for standard maintenance.

[NotReady4PrimeTime, RN]

Our cardiacs come back from the OR with Ringers running. We change it to D5NS right away. We always use D5NS because hyponatremia in children is a very serious and quite common complication of illness. Hyponatremic encephalopathy arising from the administration of hypotonic IV solutions is more common than believed and brings with it significant morbidity, as well as increased mortality. Water Water Everywhere: Standardizing Postoperative Fluid Therapy with 0.9% Normal Saline explains the rationale for this change in practice that occurred for us in 2004.

[KelRN215, BSN, RN]

In nearly 5 years as an acute care peds nurse, I think I gave LR ONCE. We didn't stock it on the floor and even the pharmacy didn't stock it... I think I had to get it from the OR because they were the only place in the entire hospital that used it.

[PediLove2147, BSN, RN]

Is this a peds thing? I am on an adult floor and use LR as a maintenance all the time.