Usage
- Medical Conditions: This combination, often referred to as Lactated Ringer’s Solution or Hartmann’s Solution, is primarily used to treat or prevent dehydration caused by various factors such as vomiting, diarrhea, surgery, or burns. It is also used to treat mild to moderate metabolic acidosis (except lactic acidosis) and to replace fluid and electrolyte loss. It is not indicated for treating severe potassium deficiency.
- Pharmacological Classification: Fluid and electrolyte replenisher, systemic alkalizer.
- Mechanism of Action: Replenishes fluids, electrolytes (sodium, potassium, calcium, and chloride), and acts as an alkalizing agent through the metabolism of lactate to bicarbonate in the liver. This helps restore the body’s fluid and electrolyte balance, correct acidosis, and promote diuresis.
Alternate Names
- Lactated Ringer’s Solution
- Hartmann’s Solution
- Ringer’s Lactate Solution
- Compound Sodium Lactate Solution
How It Works
- Pharmacodynamics: Expands the extracellular fluid compartment, including both interstitial and intravascular fluid. Lactate is metabolized to bicarbonate, increasing blood pH and correcting acidosis. Restores electrolyte balance crucial for cellular function.
- Pharmacokinetics: Administered intravenously; thus, absorption is immediate and complete. Sodium, potassium, and chloride are distributed throughout the extracellular fluid. Calcium distribution is complex, involving binding to plasma proteins and storage in bone. Lactate is metabolized primarily by the liver to bicarbonate. Elimination of electrolytes occurs mainly through renal excretion. Elimination pathways for lactate includes hepatic metabolism.
- Mode of Action: Primarily replaces lost fluids and electrolytes. The lactate component provides bicarbonate precursors that increase blood pH.
Dosage
Standard Dosage
Adults: 500 ml to 3 liters/24h. The infusion rate is usually 40 ml/kg/24h. In cases of hypovolemia or hypotension, the amount needed to restore normal blood volume is estimated at 3 to 5 times the volume of blood lost.
Children: 20 ml to 100 ml/kg/24h. The infusion rate varies with age: 6-8 ml/kg/h for infants, 4-6 ml/kg/h for toddlers, and 2-4 ml/kg/h for school children.
Special Cases:
- Elderly Patients: Dose selection should be cautious, usually starting at the low end of the dosing range, due to potential age-related decreases in hepatic, renal, or cardiac function.
- Patients with Renal Impairment: Use with caution due to the risk of sodium and potassium retention. Close monitoring of serum electrolytes is essential.
- Patients with Hepatic Dysfunction: Lactate metabolism may be impaired; use with caution.
- Patients with Comorbid Conditions: Use with caution in patients with congestive heart failure, severe renal insufficiency, hyperkalemia, hypercalcemia, metabolic alkalosis, and conditions associated with increased lactate levels.
Clinical Use Cases
- Intubation: Used as a maintenance fluid during and after the procedure.
- Surgical Procedures: Used to maintain fluid and electrolyte balance before, during, and after surgery.
- Mechanical Ventilation: Used as a maintenance fluid.
- Intensive Care Unit (ICU) Use: Used for fluid resuscitation and electrolyte management.
- Emergency Situations: Used in shock, hemorrhage, and other emergency situations requiring rapid fluid replacement.
Dosage Adjustments
Dose adjustments are necessary in patients with renal or hepatic impairment, cardiac disease, or conditions affecting electrolyte balance. Monitoring of serum electrolyte levels is necessary to guide therapy.
Side Effects
Common Side Effects
Rare but Serious Side Effects
- Fluid overload
- Electrolyte imbalances (hyperkalemia, hypernatremia, hypercalcemia)
- Allergic reactions
Long-Term Effects
Generally, not intended for long-term use.
Adverse Drug Reactions (ADR)
- Anaphylaxis
- Pulmonary edema
Contraindications
- Known hypersensitivity to sodium lactate
- Hyperkalemia
- Hypercalcemia
- Severe renal failure
- Congestive heart failure
- Neonates receiving ceftriaxone
Drug Interactions
- Ceftriaxone: Risk of fatal precipitation in neonates.
- Corticosteroids/Steroids, Carbenoxolone: Increased sodium and water retention.
- Thiazide diuretics or Vitamin D: May lead to hypercalcemia.
- Lithium: Potential interaction with antipsychotics.
Pregnancy and Breastfeeding
Lactated Ringer’s solution can be used during pregnancy and breastfeeding if clinically indicated and electrolyte and fluid balance are carefully monitored. Calcium will pass into breast milk.
Drug Profile Summary
- Mechanism of Action: Replenishes fluid and electrolytes, corrects acidosis.
- Side Effects: Nausea, vomiting, fluid overload, electrolyte imbalances, allergic reactions.
- Contraindications: Hypersensitivity to sodium lactate, hyperkalemia, hypercalcemia, severe renal failure, congestive heart failure. Neonates receiving ceftriaxone.
- Drug Interactions: Ceftriaxone, corticosteroids, thiazide diuretics, vitamin D, lithium.
- Pregnancy & Breastfeeding: Can be used with caution and monitoring.
- Dosage: Adults: 500ml to 3L/24h, Children: 20-100 ml/kg/24h.
- Monitoring Parameters: Serum electrolytes, fluid balance, blood pressure, heart rate, urine output.
Popular Combinations
Often used alone. May be combined with other medications based on patient-specific needs.
Precautions
- Monitor fluid and electrolyte balance closely.
- Use with caution in patients with renal or hepatic impairment, cardiac disease, or conditions affecting electrolyte balance.
- Avoid extravasation during IV administration.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Calcium Chloride + Potassium Chloride + Sodium Chloride + Sodium Lactate?
A: Adults: 500 ml to 3 liters/24h. Children: 20 ml to 100 ml/kg/24h. Dosage adjustments are necessary for specific patient populations.
Q2: What are the primary uses of this solution?
A: Treating and preventing dehydration, managing mild to moderate metabolic acidosis (except lactic acidosis), and replacing fluid and electrolyte loss.
Q3: Are there any significant drug interactions?
A: Yes. Notably, ceftriaxone should be avoided in neonates. Other interactions exist with corticosteroids, thiazide diuretics, vitamin D, and lithium.
Q4: Can this solution be used during pregnancy and breastfeeding?
A: It can be used if clinically indicated and with careful monitoring of fluid and electrolyte balance.
Q5: What are the common side effects?
A: Nausea and vomiting are common. More serious but rare side effects include fluid overload, electrolyte imbalances, and allergic reactions.
Q6: What are the contraindications for this medication?
A: Hypersensitivity to any component, hyperkalemia, hypercalcemia, severe renal failure, congestive heart failure, and concomitant use of ceftriaxone in neonates.
Q7: What monitoring is required during administration?
A: Close monitoring of serum electrolytes, fluid balance, blood pressure, heart rate, and urine output are essential.
Q8: How is this solution administered?
A: Intravenous infusion.
Q9: What is the mechanism by which this solution corrects acidosis?
A: Lactate is metabolized by the liver to bicarbonate, which helps raise blood pH.
