Ringer’s lactate solution

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. 

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). 

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 )... 

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...

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. )... 

Intravenous replacement solutions are a source of electrolytes and water for hydration (Normosol M Ringer s Injection, Lactated Ringer s, Plasma-Lyte R), and used to facilitate amino acid utilization and maintain electrolyte balance (Lypholyte, Multilyte, TPN Electrolytes). Dextrose and electrolyte solutions such as Plasma-Lyte R and 5% dextrose are used as a parenteral source of electrolytes, calories, or water for hydration. Invert sugar-electrolyte solutions, such as Multiple Electrolytes and Travert 5% and 10%, contain equal parts of dextrose and fructose and are used as a source of calories and hydration. 

Combined electrolyte solutions are available for oral and IV administration. The IV solutions contain various electrolytes and dextrose. The amount of electrolytes, given as milliequivalents per liter (mEq/L), also varies. The IV solutions are used to replace fluid and electrolytes that have been lost and to provide calories by means of their carbohydrate content. Examples of IV electrolyte solutions are dextrose 5% with 0.9% NaCl, lactated Ringer s injection, Plasma-Lyte, and 10% Travert (invert sugar—a combination of equal parts of fructose and dextrose) and Electrolyte No. 2. 

The dangers of shock are avoided or treated by intravenous infusion of large volumes of a salt-containing solution that is isotonic with blood (has the same osmotic pressure as blood), usually one known as lactated Ringer s solution. The added liquid increases blood volume and blood flow, thereby improving oxygen delivery. The HCO / H2C03 ratio then increases toward normal and allows the severely injured person to survive. 

Use a crystalloid (normal saline or lactated Ringer s solution) or a colloid (hydroxyethyl starch or albumin 5%) intravenous boluses... 

If serum sodium rises more than 150 mEq/L or when euv-olemic, switch to hypotonic fluid replacement. Lactated Ringer s solution may prolong ketoacid production by promoting alkalinization... 

Therapeutic fluids include crystalloid and colloid solutions. The most commonly used crystalloids include normal saline, hypertonic saline, and lactated Ringer s solution. Examples of colloids include albumin, the dextrans, hetastarch, and fresh frozen plasma. 

For patients with fluid deficits, it is safer and more cost-effective to correct fluid abnormalities using standard intravenous fluids (e.g., sodium chloride 0.9% in water, dextrose 5% in water, and lactated Ringer s solution). Minimizing fluid volume in PN may be indicated in patients with fluid overload, such as critically ill patients who receive large-volume resuscitation fluids, patients with oliguric (urine output less than 400 mL/day) or anuric (urine output less than 50 mL/day) renal failure, and those with congestive heart failure. It is reasonable to... 

Fig. 4 Human corneal endothelium following 3-hour perfusion with lactated Ringer s solution (a) scanning electron micrograph (2100 x) (b) transmission electron micrograph (9100 x ). (Courtesy of H. Edelhauser.)... 

While the lactate-H+ symporter and the K+/H+ exchanger are involved in acidification of the cell, the Na+/H+ exchanger present in the basal cells exports protons out of the cell in exchange for Na+ [139]. It was observed that removal of Na+ from the Ringer s solution decreased intracellular pH by 0.5 unit in basal cells, possibly due to inhibition of the Na+/H+ exchanger. As the basal cells are the precursors for the superficial cells of the corneal epithelium, it is quite likely that similar exchange processes are also present in the superficial layer, the principal barrier to ion and drug transport [99,103],... 

FIGURE 12-1. (Continued) B. Ongoing management of inadequate tissue perfusion. (CHF, congestive heart failure LR, lactated Ringer s solution.)... 

Crystalloids consist of electrolytes (e.g., Na+, Cl-, K1) in water solutions, with or without dextrose. Lactated Ringer s solution may be preferred because it is unlikely to cause the hyperchloremic metabolic acidosis seen with infusion of large amounts of normal saline. 

Albumin 5% and 25% concentrations are available. It takes approximately three to four times as much lactated Ringer s or normal saline solution to yield the same volume expansion as 5% albumin solution. However, albumin is much more costly than crystalloid solutions. The 5% albumin solution is relatively iso-oncotic, whereas 25% albumin is hyperoncotic and tends to pull fluid into the compartment containing the albumin molecules. In general, 5% albumin is used for hypovolemic states. The 25% solution should not be used for acute circulatory insufficiency unless diluted with other fluids or unless it is being used in patients with excess total body water but intravascular depletion, as a means of pulling fluid into the intravascular space. 

In the initial hour of treatment, a large volume of IV solution (lactated Ringer s solution) may need to be administered to restore intravascular volume. This may be followed by up to 1 L/hour until fluid balance is restored in a few hours. 

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