This can confuse the interpretation of lactate levels. The goal of therapy is to draw out free water from brain parenchyma using hypertonic fluid administration. Although studies have compared the 2, a single study compared conventional fluid resuscitation versus hypertonic saline in hypotensive patients with traumatic brain injury in the prehospital setting.
Findings were nearly identical neurological function 6 months after the injury between the 2 groups; however, conventional therapy is to avoid isotonic saline in the acute setting.
Patients on any intravenous fluid replacement need to be monitored for fluid overload. As stated above, any crystalloid fluid distributes across the extracellular fluid compartment equally in an approximately 3 to 1 ratio interstitial: intravascular under normal physiologic conditions.
Giving too much crystalloid fluid causes fluid overload that can progressively worsen peripheral and pulmonary edema. High-risk patients at high risk for fluid overload include those with congestive heart failure, renal disease, and liver cirrhosis. In these cases, IV fluid administration should proceed cautiously. Monitoring of the site of infusion and IV access is necessary to make sure that the fluid is, in fact, being delivered into the vein.
IV sites should be monitored for any signs of infiltration, redness, pain, swelling, or discomfort. If present, the infusion should be stopped, and other IV access should be established.
As previously stated, excessive IV fluid administration can cause fluid overload. Patients may present anywhere on the spectrum from mild peripheral edema to respiratory distress secondary pulmonary edema. Symptomatic patients should be given diuretic therapy and have serum electrolytes monitored closely.
In the most severe cases of respiratory distress, patients may require noninvasive positive pressure ventilation or even intubation. Asymptomatic fluid overload can be managed conservatively with fluid restriction and continued monitoring. All interprofessional healthcare team members should be familiar with Ringer's lactate and its indications. In many clinical scenarios, lactate is a beneficial molecule, given its metabolism.
The solution is safe; the only drawback results not from electrolyte changes but the fluid overload that may occur. Hence attention should be paid to the amount of volume infused. This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Continuing Education Activity Ringer's lactate solution, or lactated Ringer's solution, is a type of isotonic, crystalloid fluid further classified as a balanced or buffered solution used for fluid replacement.
Provides the body with sodium lactate: Sodium lactate is a bioenergetic fuel that the human body is designed to metabolize under ischemic conditions, thus decreasing cellular death from ischemia.
Monitoring Patients on any intravenous fluid replacement need to be monitored for fluid overload. Enhancing Healthcare Team Outcomes All interprofessional healthcare team members should be familiar with Ringer's lactate and its indications.
Review Questions Access free multiple choice questions on this topic. Comment on this article. References 1. Ringer's lactate versus normal saline in acute pancreatitis: A systematic review and meta-analysis. J Dig Dis. Gladden LB. Nursing Responsibilities Do not administer unless solution is clear and container is undamaged.
Caution must be exercised in the administration of parenteral fluids, especially those containing sodium ions to patients receiving corticosteroids or corticotrophin. Solution containing acetate should be used with caution as excess administration may result in metabolic alkalosis. Solution containing dextrose should be used with caution in patients with known subclinical or overt diabetes mellitus.
Discard unused portion. Develop and improve products. List of Partners vendors. If you've ever had surgery or been sick or injured enough to require hospitalization, there's a good chance you were given something called lactated Ringer's solution. This oddly-named fluid is delivered via IV intravenously, which means into a vein to treat dehydration, deliver medication, and restore fluid balance following an injury.
Ringer's solution was developed in the lates by a British physician named Sydney Ringer for keeping organs hydrated during live animal research. In the s, a physician named Alexis Hartmann modified Ringer's original formula by adding lactate, which he found lowered the risk of acidosis the abnormal buildup of acid in the blood. Other variations of Ringer's solution exist, such as one that includes acetate which may be better for people with liver disease since lactate tends to increase as the liver function decreases.
It is more beneficial than saline solution in that it doesn't remain in the body for as long and so is less likely to cause fluid overload. The addition of lactate reduces acidity as it is converted by the body into bicarbonate, a base element that helps regulate the body's pH balance.
Acidosis commonly occurs when the liquid portion of the blood is too low—a condition called hypovolemia. Lactated Ringer's solution also is ideal for people with sepsis , kidney failure , or respiratory acidosis whose acid-base balance is characteristically thrown off. Lactated Ringer's solution can also be used for non-intravenous purposes, such as flushing wounds and irrigating tissues during open surgery.
It should not be swallowed, however. Lactated Ringer's solution is generally safe and well-tolerated but may cause swelling and edema fluid buildup in tissue if overused. Injection site pain is the most common side effect. Very rarely a person will have an allergic reaction to Ringer's.
Lactated Ringer's solution may also be a problem for people who are unable to effectively clear fluids from the body, such as those with congestive heart failure , chronic kidney disease , cirrhosis , and hypoalbuminemia a common cause of hypovolemia.
There is no outright contraindication for using lactated Ringer's solution, but it should not be given to someone with severe liver dysfunction. Careful consideration should also be made for people with heart or kidney disease. Lactated Ringer's solution doesn't mix well with certain drugs intended for intravenous use.
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