Ringer’s solutions

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 this connection it is interesting to recall Kremer s experiments. By means of a spectroscopic method, Kremer demonstrated that when air saturated with an odoriferous substance such as pyridine or camphor is bubbled through a liquid containing a lipoid—such as a suspension of lecithin of a fatty animal tissue in Ringer s solution—more of the odoriferous substance is adsorbed than when the saturated air passes through water only. 

Edwards e/a/. carried out controlled potential, slow strain-rate tests on Zimaloy (a cobalt-chromium-molybdenum implant alloy) in Ringer s solution at 37°C and showed that hydrogen absorption may degrade the mechanical properties of the alloy. Potentials were controlled so that the tensile sample was either cathodic or anodic with respect to the metal s free corrosion potential. Hydrogen was generated on the sample surface when the specimen was cathodic, and dissolution of the sample was encouraged when the sample was anodic. The results of these controlled potential tests showed no susceptibility of this alloy to SCC at anodic potentials. 

Bundy, K. J., Vogelbaum, M. A. and Desai, V. H., The Influence of Static Stress on the Corrosion Behaviour of 316L Stainless Steel in Ringer s Solution , Journal of Biomedical Materials Research, 20, 493-505 (1986)... 

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. 

Volume replacement is crucial in antianaphylactic treatment. It should be started with crystalloid solution (saline or Ringer s solution). However, in severe shock, higher... 

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],... 

Initial fluid resuscitation consists of isotonic crystalloid (0.9% sodium chloride or lariated Ringer s solution), colloid (5% Plasmanate or albumin, 6% hetastarch), or whole blood. Choice of solution is based on 02-carrying capacity (e.g., hemoglobin, hematocrit), cause of hypovolemic shock, accompanying disease states, degree of fluid loss, and required speed of fluid delivery. 

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. 

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. 

Fluid administration should be titrated to clinical endpoints such as heart rate, urine output, blood pressure, and mental status. Isotonic crystalloids, such as 0.9% sodium chloride or lactated Ringer s solution, are commonly used for fluid resuscitation. 

In brief, the rats are anesthetized, followed by an injection of 0.2 mL of the test solution into the common carotid artery. The injection solution consists of a HEPES buffered Ringer s solution (containing 141 mM NaCl, 4 mM KC1, 2.8 mM CaCl2, and 10 mM HEPES, pH 7.4) which contains both the test substrate (e.g., a [3H]-labeled compound, about 10 /xCi) and a reference compound, which is highly extracted by the tissue (e.g., 0.1 /xCi [14C]n-butanol) in the presence or absence of transport inhibitors. If a [14C]-labeled compound is used as a test substrate, [3H]H20 can be selected as a reference compound. Rats are decapitated at 15 s after injection and the retina is removed. The retina is dissolved in 2 N NaOH and subsequently neutralized with 2 N HC1. The radioactivity is measured by liquid scintillation spectrometry. The RUI value, an index of the retinal distribution characteristics of the [3H] test substrate, is estimated using the following relationship ... 

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