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Lactated Ringer solution: Drug information

Lactated Ringer solution: Drug information
(For additional information see "Lactated Ringer solution: Pediatric drug information")

For abbreviations and symbols that may be used in Lexicomp (show table)
Pharmacologic Category
  • Electrolyte Supplement, Parenteral
Dosing: Adult

Alkalinizing agent, replacement: IV: Volume, rate and duration are to be individualized and dependent upon the indication for use, patient age, weight, concomitant treatment and clinical condition as well as laboratory determinations.

Irrigation: Dose dependent on area to be irrigated and the procedure.

Septic shock or sepsis-induced hypoperfusion, fluid resuscitation (off-label use): IV: Minimum of 30 mL/kg to be given within the first 1 hour of identification of sepsis for initial resuscitation; following initial resuscitation, additional fluid administration guided by frequent reassessment of hemodynamic status. Note: Some patients may require more rapid administration and/or greater amount of fluid for initial resuscitation. An unbalanced isotonic crystalloid solution (eg, normal saline) is also appropriate for this indication (Rhodes 2017; SCCM [Levy 2018]).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Intravenous:

Generic: (250 mL, 500 mL, 1000 mL)

Solution, Intravenous [preservative free]:

Generic: (250 mL, 500 mL, 1000 mL)

Solution, Irrigation:

Generic: (1000 mL, 2000 mL, 3000 mL, 4000 mL [DSC], 5000 mL)

Solution, Irrigation [preservative free]:

Generic: (3000 mL)

Generic Equivalent Available: US

Yes

Administration: Adult

IV: For IV use only. Consult individual institutional policies and procedures.

Irrigation: For irrigation use only.

Use: Labeled Indications

Injection:

Alkalinizing agent: Use as an alkalinizing agent.

Replacement: Source of electrolytes and water.

Irrigation: For general irrigation, washing, and rinsing.

Use: Off-Label: Adult

Septic shock or sepsis-induced hypoperfusion, fluid resuscitation

Contraindications

Injection: Hypersensitivity to sodium lactate or any component of the formulation; concomitant use with ceftriaxone in neonates (≤28 days).

Irrigation: Parenteral administration; irrigation during electrosurgical procedures.

Warnings/Precautions

Disease-related concerns:

• Alkalosis: Administer with extreme caution, if at all, to patients with alkalosis or at risk for alkalosis. Lactate is metabolized to bicarbonate and may worsen metabolic alkalosis.

• Cardiovascular: Use with caution in patients with cardiovascular disease or insufficiency. Use with caution in patients with heart failure.

• Diabetes: Use with caution in patients with type 2 diabetes; lactate is a substrate for gluconeogenesis.

• Fluid overload: May occur, resulting in dilution of serum electrolyte concentrations, overhydration, congested states, pulmonary edema, or acid-base imbalance. Use with extreme caution, if at all, in patients with hypervolemia, overhydration, edema, or conditions that may cause sodium and/or fluid overload.

• Hepatic impairment: Use with extreme caution, if at all, in patients with severe hepatic insufficiency because of impaired lactate metabolism.

• Hypercalcemia: Use with caution in patients with hypercalcemia or conditions predisposing to hypercalcemia (eg severe renal impairment, granulomatous diseases associated with increased calcitriol synthesis such as sarcoidosis or renal calculi).

• Hyperkalemia: Use with extreme caution, if at all, in patients with hyperkalemia or conditions predisposing to hyperkalemia (eg, severe renal impairment, adrenocortical insufficiency, acute dehydration, extensive tissue injury or burns).

• Hypersensitivity reactions: May occur. Discontinue infusion immediately if signs/symptoms of a hypersensitivity reaction develop.

• Renal impairment: Use with extreme caution, if at all, in patients with severe renal insufficiency. May cause potassium and/or sodium retention.

Special populations:

• Pediatric: Use with caution in neonates and infants <6 months of age.

Other warnings/precautions:

• Appropriate use:

- Injection: Not for the treatment of lactic acidosis or severe metabolic acidosis. LR is insufficient to produce a useful effect in case of severe potassium deficiency and should not be used for this purpose. Should not be administered simultaneously with citrate anticoagulated/preserved blood through the same administration set because of the likelihood of coagulation.

- Irrigation: Use with caution when used for continuous irrigation or in body cavities; possible absorption and circulatory overload may occur.

Metabolism/Transport Effects

None known.

Drug Interactions

CefTRIAXone: Ringer's Injection (Lactated) may enhance the adverse/toxic effect of CefTRIAXone. Ceftriaxone binds to calcium in the Lactated Ringer's forming an insoluble precipitate. Management: Use of ceftriaxone is contraindicated in neonates (28 days of age or younger) who require (or are expected to require) treatment with IV calcium-containing solutions (ie, LR). In older patients, flush lines with compatible fluid between administration. Risk D: Consider therapy modification

Monitoring Parameters

Serum sodium, potassium, chloride, calcium, bicarbonate concentrations, acid-base balance, and osmolarity; I & O, weight. Monitor infusion site.

REFERENCES

  1. Lactated Ringer's Injection, USP [prescribing information]. Lake Zurich, IL: Fresenius Kabi; November 2018.
  2. Lactated Ringer's Irrigation [prescribing information]. Bethlehem, PA: B. Braun Medical Inc; August 2018.
  3. Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 Update. Crit Care Med. 2018;46(6):997-1000. doi:10.1097/CCM.0000000000003119 [PubMed 29767636]
  4. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304-377. doi:10.1007/s00134-017-4683-6 [PubMed 28101605]
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