Ringer’s lactate

Ringer s Lactate. In 1883, it was discovered that the excised ventricle of the frog would beat for some hours if suppHed with an aqueous solution of sodium, potassium, and calcium salts. The concentration of potassium and calcium was found to be critical, whereas the amounts of the anions had htde effect on the frog heart. The composition of this saline, coined Ringer s solution, is given in Table 1. Many years later it was shown to be very close to that of frog plasma. 

Ringer s lactate, in which lactate is added to Ringer s solution, is probably the most popular crystalloid (salt) solution for intravenous use in humans. The lactate is gradually converted to sodium bicarbonate within the body so that an uncompensated alkalosis is prevented (13). These crystalloid solutions cannot support life without red cells saline passes rather quickly into the tissue spaces of various organs (14), especially the Hver (15). 

In 1982 a study of the usefulness of DBBF in the production of a blood substitute was reported (99). A single modification achieved the dual goals of reduced oxygen affinity and restricted tetramer—dimer dissociation. This work was confirmed in 1987 (98). The product, called aa-hemoglobin, was formulated in Ringer s lactate. P q under physiologic conditions is 3.7 kPa (28.0 torr). Hill s parameter is 2.2, and the Bohr effect was reduced (100). Plasma retention was increased, and the product appeared to be less heterogeneous than some of the other derivatives under study. Its production was scaled up by Baxter Healthcare Corp., under contract to the U.S. Army. 

This isotonic volume expander contains sodium, potassium, chloride, and lactate that approximates the fluid and electrolyte composition of the blood. Ringer s lactate (also known as lactated Ringer s or LR) provides ECF replacement and is most often used in the perioperative setting, and for patients with lower GI fluid losses, burns, or dehydration. The lactate component of LR works as a buffer to increase the pH. Large volumes of LR may cause metabolic alkalosis. Because patients with significant liver disease are unable to metabolize lactate sufficiently, Ringer s lactate administration in this population may lead to accumulation of lactate with iatrogenic lactic acidosis. The lactate is not metabolized to bicarbonate in the presence of liver disease and lactic acid can result. 

Weight loss of 9% to 10% is considered severe and requires IV fluid replacement with Ringer s lactate or 0.9% sodium chloride. IV therapy is also indicated in patients with uncontrolled vomiting, the presence of paralytic ileus, stool output greater than 10 mL/kg/hour, shock, or loss of consciousness. 

The mainstay of treatment for cholera consists of fluid and electrolyte replacement with ORT to restore fluid and electrolyte losses. Rice-based rehydration formulations are the preferred ORT for cholera patients. In patients who cannot tolerate ORT, IV therapy with Ringer s lactate can be used. 

The characteristics of the fluid to be injected will also influence the choice of parenteral routes. The drug must be compatible with other fluids (e.g., saline, dextrose, Ringer s lactate) with which it may be combined for administration to the patient, as well as with the components of the blood itself. 

Half strength of normal saline Ringer s lactate... 

Compatible IV solutions - 0.9% sodium chloride injection, 5% dextrose (D5W) injection, D5W/0.9% sodium chloride injection, D5W in Ringer s lactate, Plasma-Lyte... 

Solution 0.9% NaCI Ringer s solution Ringer s Lactate Modified gelatin (Gelofusine )... 

NaCI Ringer s lactate 4% albumin Modified gelatin Urea-linked gelatin Dextran 40 (10%)... 

Ringer s lactate TO ml/kg in t5-30 minutes, then 20-T0 ml/kg it skin turgor, alertness, and puke have not returned to normal or... 

Ringer s lactate or normal saline 20 ml/kg repeat it necessary, and then replace water and electrolyte deticits over t-2 days Followed by ORT 100 mt/kg over T hours. 

Figure 8.15 Prevention of insulin loss via adsorption by the addition of human serum albumin (HSA) or Plasmanate to 1000 cm of Ringer s lactate (RL) solution in a glass bottle. Insulin (30 units) was injected and measured at 5 min. Values represent means SEM. All HSA and Plasmanate values were significantly different from Ringer lactate solution control...

Regardless of the serotypes, the primary goal of therapy is restoration of fluid and electrolyte losses caused by watery diarrhea. ORT is the preferred method of rehydration, and several studies showed reduction in fluid requirements by 32% to 35% when rice-based instead of glucose-based ORT solutions are used (50-80 g rice instead of 20 g glucose per liter). In patients who cannot tolerate ORT, IV Ringer s lactate solution can be used. Normal saline is not recommended because it does not correct metabolic acidosis. After rehydration, maintenance fluid is given based on accurate recording of intake and output volumes. 

The client with a full-thickness burn over 38% of the body is admitted to the burn unit 4 hours after the fire. The HCP writes an order for Ringer s lactate 450 mL/hour. Which action should the nurse implement ... 

The client who has had abdominal surgery has an IV of Ringer s lactate infusing at 150 mL/hour. The nurse is hanging a new bag of fluid. The IV administration set delivers 10 gtts/mL. At what rate would the nurse set the infusion ... 

Ringer . lactate, a solution containing several different salts, is often administered intravenously for the initial treatment of trauma patients. One liter of Ringer s lactate contains 0.102 mole of sodium chloride, 4 X 10 mole of potassium chloride, 1.5 X 10 mole of calcium chloride, and 2.8 X 10 mole of sodium lactate. Determine the osmotic pressure of this solution at normal body temperature (37 C). Assume no ion pairing. (The formula of the lactate ion is CHiCH COO. )... 

Think About It Ringer s lactate is isotonic with human plasma, which is often the case with fluids administered intravenously. 

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