Sodium Lactate

Usage

• Sodium Lactate is prescribed for the prevention or control of mild to moderate metabolic acidosis in patients with restricted oral intake, particularly when oxidative processes are not severely impaired. It’s also used for fluid resuscitation in hypovolemia, hypotension, and conditions with extracellular fluid loss. It can also be used as a vehicle for compatible intravenous drugs. Compound Sodium Lactate Solution (Hartmann’s/Ringer’s Lactate) is used for fluid and electrolyte replacement, as a source of bicarbonate for mild to moderate metabolic acidosis (excluding lactic acidosis), and as a vehicle for intravenous drug delivery.

• Pharmacological classification: Systemic alkalizer, fluid and electrolyte replenisher.

• Mechanism of action: Sodium lactate is metabolized in the liver to bicarbonate, thereby increasing blood bicarbonate levels and raising pH, correcting acidosis.

Alternate Names

• Sodium lactate solution; Hartmann’s solution; Ringer’s lactate solution; Compound Sodium Lactate Solution for Infusion BP.

• Brand Names: Aviva.

How It Works

• Pharmacodynamics: Sodium lactate is metabolized in the liver to bicarbonate, increasing blood bicarbonate concentration and raising pH. This conversion depends on adequate liver function and perfusion. The sodium content helps restore extracellular fluid volume.

• Pharmacokinetics: Administered intravenously, lactate is rapidly distributed in the extracellular compartment and metabolized primarily in the liver to bicarbonate. Excretion of lactate is negligible, with the primary route of elimination being through its conversion to bicarbonate, which is then regulated by the body’s acid-base homeostasis mechanisms. Clearance of lactate can be reduced in hepatic insufficiency.

• Mode of Action: The lactate anion is converted to bicarbonate in the liver via the Cori cycle. This involves the oxidation of lactate to pyruvate, followed by the carboxylation of pyruvate to oxaloacetate, which is then decarboxylated to phosphoenolpyruvate and finally converted to glucose. This process consumes hydrogen ions (H+), thereby increasing pH. Sodium contributes to extracellular fluid volume expansion.

Dosage

Standard Dosage

Adults:

• 500 ml to 3 L/24h IV.
• Infusion rate: Usually 40 mL/kg/24h. In medical emergencies or surgery, higher infusion rates and volumes may be necessary, depending on the patient’s fluid and electrolyte requirements.

Children:

• 20 to 100 mL/kg/24h IV.
• Pediatric infusion rates vary with age: 6–8 mL/kg/h for infants, 4–6 mL/kg/h for toddlers, and 2–4 mL/kg/h for older children.
• For burns: 3.4 mL/kg/percent burn at 24 hours and 6.3 mL/kg/percent burn at 48 hours post-burn.
• For head injuries: 2850 mL/m².
• Caution is advised in neonates and infants less than six months.

Special Cases:

• Elderly patients: Adjust dosage based on renal and hepatic function and comorbid conditions.
• Patients with renal impairment: Administer with caution due to potential sodium and potassium retention. Adjust dosage based on creatinine clearance.
• Patients with hepatic dysfunction: Administer with caution due to impaired lactate metabolism.
• Patients with comorbid conditions: Adjust dosage based on individual needs.

Clinical Use Cases:

• Intubation: As part of fluid resuscitation during and after the procedure.
• Surgical Procedures: For perioperative fluid management.
• Mechanical Ventilation: As part of fluid and electrolyte management.
• ICU Use: For fluid and electrolyte management in critically ill patients.
• Emergency Situations: For rapid fluid resuscitation in hypovolemic or hypotensive shock. Initial bolus: Adults: 250 ml IV; Children: 20 ml/kg IV. Repeated as needed.

Dosage Adjustments:

• Adjust dosage based on patient factors such as age, weight, clinical condition, renal and hepatic function, concomitant medications, and clinical and laboratory response.
• Monitor serum electrolytes, acid-base balance, and fluid status before and during administration.

Side Effects

Common Side Effects:

• Edema, hypernatremia, hyperkalemia, hypercalcemia, metabolic alkalosis.

Rare but Serious Side Effects:

• Pulmonary edema, cardiac arrhythmias, tetany (due to calcium excess), mental confusion.

Adverse Drug Reactions (ADR):

• Hypersensitivity reactions (including angioedema). If any sign of hypersensitivity develops, the infusion must be stopped immediately and appropriate countermeasures instituted.

Contraindications

• Hypernatremia.
• Fluid retention.
• Severe liver disease or impaired lactate utilization.
• Lactic acidosis.
• Conditions that may cause sodium and/or potassium retention, fluid overload, or edema.
• Alkalosis or predisposition to alkalosis.

Drug Interactions

• Potassium-sparing diuretics, ACE inhibitors, angiotensin II receptor blockers, and immunosuppressants (such as tacrolimus and cyclosporine) can increase risk of hyperkalemia.
• Corticosteroids and corticotropin can increase sodium retention.
• Sodium bicarbonate is an additive incompatibility.

Pregnancy and Breastfeeding

• Pregnancy Safety Category: C. Use with caution if benefits outweigh risks.
• Breastfeeding: Lactate is excreted in breast milk. Exercise caution.

Drug Profile Summary

• Mechanism of Action: Conversion of lactate to bicarbonate in the liver, increasing bicarbonate levels and correcting acidosis. Provides sodium to support extracellular fluid volume.

• Side Effects: Edema, electrolyte imbalances, metabolic alkalosis.

• Contraindications: Hypernatremia, fluid retention, lactic acidosis, severe liver disease.

• Drug Interactions: Potassium-sparing diuretics, ACE inhibitors, ARBs, corticosteroids.

• Pregnancy & Breastfeeding: Use with caution.

• Dosage: Adults: 500ml-3L/24h IV. Children: 20-100ml/kg/24h IV. Adjustments for renal/hepatic impairment.

• Monitoring Parameters: Serum electrolytes (sodium, potassium, chloride, calcium), arterial blood gases (pH, bicarbonate, pCO2), fluid balance, vital signs.

Popular Combinations

• Often used as a component of resuscitation fluids, combined with other electrolytes.

Precautions

• Monitor fluid status, electrolytes, and acid-base balance.
• Use cautiously in patients with cardiac, renal, or hepatic impairment.
• Adjust dose based on individual patient needs.

FAQs

Q1: What is the recommended dosage for Sodium Lactate?

A: Adults: 500 mL to 3L/24 hrs IV. Children: 20-100 mL/kg/24 hrs IV. Dosage must be individualized and adjusted based on clinical condition and lab results.

Q2: How does Sodium Lactate correct metabolic acidosis?

A: Sodium lactate is metabolized to bicarbonate in the liver, which raises blood bicarbonate levels and corrects the acidosis.

Q3: What are the contraindications to using sodium lactate?

A: Lactic acidosis, hypernatremia, fluid retention, severe liver disease.

Q4: Can Sodium Lactate be used in children?

A: Yes, but with careful monitoring, and dosage should be adjusted based on weight and age. Special caution in neonates and infants under 6 months old.

Q5: Are there specific monitoring requirements during sodium lactate administration?

A: Yes. Monitor serum electrolytes, arterial blood gases, and patient fluid status before and during administration.

Q6: Can sodium lactate be combined with other medications in the same IV line?

A: Compatibility with additives should be assessed before mixing with other drugs in the same IV solution. Check for discoloration or precipitation. Sodium bicarbonate is an additive incompatibility.

Q7: How should Sodium Lactate be administered?

A: Intravenously, after dilution.

Q8: What are the symptoms of sodium lactate overdose?

A: Symptoms may include fluid overload (edema, pulmonary edema), hypernatremia, hyperkalemia, hypercalcemia, and metabolic alkalosis.

Q9: What is the difference between sodium lactate and sodium bicarbonate in managing metabolic acidosis?

A: Sodium lactate works by being converted to bicarbonate in the liver, whereas sodium bicarbonate directly provides bicarbonate. Sodium lactate is not suitable for severe acidosis needing immediate correction. It is contraindicated in lactic acidosis.