What are the components of Lactated Ringers Solution?

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The other day in my ICU practicum my pt.'s lactate levels kept rising so the MDs ordered a 1L bolus of Lactated Ringer's solution. If I am correct, the fluid bolus is to flush the lactate out in order to make sure that the lactate level doesn't keep rising due to lack of tissue perfusion. Here's the question though: doesn't lactated ringers contain lactate? http://www.allivet.com/Lactated-Ringers-p/25211.htm says is contains 28mEq of lactate. So wouldn't this cancel out flushing out the lactate levels?

SIgned,

Confused

haha thanks guys

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i can only tell you its components.

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=488

leslie

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Specializes in CTICU.

The bolus is not to "flush the lactate out" but to improve cardiac output and intravascular volume so oxygenated blood can get to the tissues and restore aerobic metabolism.

LR doesn't contain enough lactate to be a huge problem provided it's fixing the cause of the lactic acidosis (hypovolemia and inadequate tissue perfusion).

Data I just read seems confusing - some articles suggest that giving blood transfusion and LR together is good because once blood flow is restored the lactate is metabolized to HCO3. Other info for LR solution says "not to be used in the treatment of lactic acidosis".... best to ask the doc his rationale?

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read the bag it's right on there.

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This creates a conundrum that is great for theoretical debate. However, we must realize that in vitro versus in vivo can vary significantly and the final word is most likely all over the place. This is especially true when looking at the literature regarding Ringers lactate.

In theory, if a person has zero lactate clearance and a condition that is causing lactic acidosis, then it is reasonable to suspect that the lactate you give will become lactic acid. However, if you are giving the RL to fix a problem such as vascular depletion and/or dehydration, then you are in fact enhancing lactate clearance and likely reversing the pathology.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
This creates a conundrum that is great for theoretical debate. However, we must realize that in vitro versus in vivo can vary significantly and the final word is most likely all over the place. This is especially true when looking at the literature regarding Ringers lactate.

In theory, if a person has zero lactate clearance and a condition that is causing lactic acidosis, then it is reasonable to suspect that the lactate you give will become lactic acid. However, if you are giving the RL to fix a problem such as vascular depletion and/or dehydration, then you are in fact enhancing lactate clearance and likely reversing the pathology.

If your only reason to give LR is to rehydrate, you can easily use .9 NS for that purpose--a great isotonic sol.

Why add the lactate with acidosis in situ?--like another poster said, I'd ask for the rationale.

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One example could include the concern over hyperchloremia and the development of hyperchloremic acidosis with the administration of 0.9% saline. In some ways, LR is a bit more balanced than normal saline.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
One example could include the concern over hyperchloremia and the development of hyperchloremic acidosis with the administration of 0.9% saline. In some ways, LR is a bit more balanced than normal saline.

Unless the sodium was a distinct issue, the .9 sol is isotonic enough not to worry about this.

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It is less about overall tonicity and more about the concentration of the chlorine ion within normal saline. You are giving somebody 154 miliequivalents of chloride per liter. This is 0.154 Eq/L, or 0.154 moles per liter using the molar mass of chlorine at approx 35.45 grams per mole. Thus, we are looking at about 5.46 grams of chlorine ion per liter. Much higher than what we normally find in plasma. Therefore, in some patients hyperchloremia can be a problem.

At the end of the day, it is typically a non issue unless we encounter at risk patients for hyperchloremia or somebody who cannot clear their lactate.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
It is less about overall tonicity and more about the concentration of the chlorine ion within normal saline. You are giving somebody 154 miliequivalents of chloride per liter. This is 0.154 Eq/L, or 0.154 moles per liter using the molar mass of chlorine at approx 35.45 grams per mole. Thus, we are looking at about 5.46 grams of chlorine ion per liter. Much higher than what we normally find in plasma. Therefore, in some patients hyperchloremia can be a problem.

At the end of the day, it is typically a non issue unless we encounter at risk patients for hyperchloremia or somebody who cannot clear their lactate.

The patient had a high lactate. Why add more?

OP didn't mention any problems with the kidneys or the deletion of sodium via normal channels--all that was mentioned was the increase in the lactate via LR, therefore I'd go with the .9 NS for rehydration.

However, that would be based on the OP's info alone and no other issues noted.

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Specializes in med surge.

I know this is old, however, a nurse on my MICU unit encountered a patient with elevated lactate and was making fun of the intern (first year resident), because he came back and said that he didn't want to give the LR for the patient due to the elevated lactate. So many times, we ICU nurses (I'm still new, so def not me) think the interns or baby docs are stupid and worthless, but case in point. Thanks all!

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