Ringer Lactate: Infusion Guidance and Precautions

Indications

• Severe dehydration.
• Fluid replacement in trauma, surgery, and anaesthesia.

Forms and strengths

500 ml and 1000 ml bottles or bags.

Composition

Varies with manufacturer. Most frequent ionic composition per litre: sodium 130.50 mmol, potassium 4.02 mmol, calcium 0.67 mmol, chloride 109.60 mmol, and lactate 28 mmol.

Ringer lactate provides appropriate amounts of sodium and calcium and 4 mEq of potassium per litre, which is sufficient for short-term use.

It contains lactate, which is converted to bicarbonate for correction of metabolic acidosis when haemodynamic and liver function are normal.

Warning: some commercially available solutions do not contain lactate.

Isotonic solution. Does not contain glucose.

Contra-indications, adverse effects, precautions

• In cases of metabolic alkalosis, diabetes, severe renal or hepatic failure, hyperkalaemia, or head injury, isotonic solution of 0.9% sodium chloride is preferred.
• After infusion, Ringer lactate remains in the intravascular compartment for 1 to 2 hours.
• For correction of hypovolaemia due to haemorrhage, administer 3 times the lost volume only if blood loss does not exceed 1500 ml in adults and cardiac and renal function are not impaired.
• Ringer lactate may also be used to prevent hypotension induced by spinal anaesthesia.
• Also comes in a premixed solution of 5% glucose and Ringer lactate, which is the preferred infusion solution for maintenance fluids in children.
• For moderate and mild dehydration, administer oral rehydration salts (ORS).