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.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Generic: (250 mL, 500 mL, 1000 mL)
Solution, Intravenous [preservative free]:
Generic: (250 mL, 500 mL, 1000 mL)
Generic: (1000 mL, 2000 mL, 3000 mL, 4000 mL [DSC], 5000 mL)
Solution, Irrigation [preservative free]:
Generic: (3000 mL)
IV: For IV use only. Consult individual institutional policies and procedures.
Irrigation: For irrigation use only.
Alkalinizing agent: Use as an alkalinizing agent.
Replacement: Source of electrolytes and water.
Irrigation: For general irrigation, washing, and rinsing.
Septic shock or sepsis-induced hypoperfusion, fluid resuscitation
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.
• 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.
• Pediatric: Use with caution in neonates and infants <6 months of age.
• 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.
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
Serum sodium, potassium, chloride, calcium, bicarbonate concentrations, acid-base balance, and osmolarity; I & O, weight. Monitor infusion site.