Lactated Ringer's solution
Encyclopedia
Lactated Ringer's solution is a solution that is isotonic
Tonicity
Tonicity is a measure of the osmotic pressure gradient of two solutions separated by a semipermeable membrane. It is commonly used when describing the response of cells immersed in an external solution...

 with blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....

 and intended for intravenous administration
Intravenous therapy
Intravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals...

. It may also be given subcutaneously.

It is grouped with intravenous fluids that are known as "crystalloids" - which include saline
Saline (medicine)
In medicine, saline is a general term referring to a sterile solution of sodium chloride in water but is only sterile when it is to be placed intravenously, otherwise, a saline solution is a salt water solution...

 and dextrose
Intravenous sugar solution
An intravenous sugar solution is a solution with a sugar used for intravenous therapy, where it may function both as a volume expander and a means of parenteral nutrition.-Types:...

 solutions (compared to the "colloids" which contain larger molecules such as starch or gelatine).

Lactated Ringer's solution is abbreviated as "LR", "RL" or "LRS". It is also known as Ringer's lactate solution (although Ringer's solution
Ringer's solution
Ringer's solution is the name given to a solution of several salts dissolved in water for the purpose of creating an isotonic solution relative to the bodily fluids of an animal. Ringer's solution typically contains sodium chloride, potassium chloride, calcium chloride and sodium bicarbonate,...

 technically refers only to the saline component, without lactate). It is very similar, though not identical to, Hartmann's Solution
Hartmann's Solution
Hartmann's solution or compound sodium lactate is a crystalloid solution that is most closely isotonic with blood and intended for intravenous administration.Hartmann's IV Infusion is used toreplace body fluid and mineral salts...

, which is more commonly found in British hospitals and has slightly different ionic concentrations.

Overview

One litre of lactated Ringer's solution contains:
  • 130 mEq of sodium
    Sodium
    Sodium is a chemical element with the symbol Na and atomic number 11. It is a soft, silvery-white, highly reactive metal and is a member of the alkali metals; its only stable isotope is 23Na. It is an abundant element that exists in numerous minerals, most commonly as sodium chloride...

     ion
    Ion
    An ion is an atom or molecule in which the total number of electrons is not equal to the total number of protons, giving it a net positive or negative electrical charge. The name was given by physicist Michael Faraday for the substances that allow a current to pass between electrodes in a...

     = 130 mmol/L
  • 109 mEq of chloride
    Chloride
    The chloride ion is formed when the element chlorine, a halogen, picks up one electron to form an anion Cl−. The salts of hydrochloric acid HCl contain chloride ions and can also be called chlorides. The chloride ion, and its salts such as sodium chloride, are very soluble in water...

     ion = 109 mmol/L
  • 28 mEq of lactate
    Lactic acid
    Lactic acid, also known as milk acid, is a chemical compound that plays a role in various biochemical processes and was first isolated in 1780 by the Swedish chemist Carl Wilhelm Scheele. Lactic acid is a carboxylic acid with the chemical formula C3H6O3...

     = 28 mmol/L
  • 4 mEq of potassium
    Potassium
    Potassium is the chemical element with the symbol K and atomic number 19. Elemental potassium is a soft silvery-white alkali metal that oxidizes rapidly in air and is very reactive with water, generating sufficient heat to ignite the hydrogen emitted in the reaction.Potassium and sodium are...

     ion = 4 mmol/L
  • 3 mEq of calcium
    Calcium
    Calcium is the chemical element with the symbol Ca and atomic number 20. It has an atomic mass of 40.078 amu. Calcium is a soft gray alkaline earth metal, and is the fifth-most-abundant element by mass in the Earth's crust...

     ion = 1.5 mmol/L


Generally, the sodium, chloride, potassium and lactate come from NaCl (sodium chloride
Sodium chloride
Sodium chloride, also known as salt, common salt, table salt or halite, is an inorganic compound with the formula NaCl. Sodium chloride is the salt most responsible for the salinity of the ocean and of the extracellular fluid of many multicellular organisms...

), NaC3H5O3 (sodium lactate
Sodium lactate
Sodium lactate is the sodium salt of lactic acid produced by fermentation of a sugar source, such as corn or beets, and then neutralizing the resulting lactic acid to create a compound having the formula NaC3H5O3. As a food additive, sodium lactate has the E number E325 and naturally is a liquid...

), CaCl2 (calcium chloride
Calcium chloride
Calcium chloride, CaCl2, is a salt of calcium and chlorine. It behaves as a typical ionic halide, and is solid at room temperature. Common applications include brine for refrigeration plants, ice and dust control on roads, and desiccation...

), and KCl (potassium chloride
Potassium chloride
The chemical compound potassium chloride is a metal halide salt composed of potassium and chlorine. In its pure state, it is odorless and has a white or colorless vitreous crystal appearance, with a crystal structure that cleaves easily in three directions. Potassium chloride crystals are...

).

There are slight variations for the composition for Ringer's as supplied by different manufacturers. As such, the term Ringer's Lactate should not be equated with one precise formulation.

Although its pH is 6.5, it is an alkalizing solution.

Development of Ringer's solution

Ringer's saline solution was invented in the early 1880s by Sydney Ringer
Sydney Ringer
Sydney Ringer FRS was a British clinician and pharmacologist, best known for inventing Ringer's solution. He was born in March 1836 in Norwich, England and died following a stroke 14 October 1910, in Lastingham, Yorkshire, England...

, a British physician and physiologist. Ringer was studying the beating of an isolated frog heart outside of the body. He hoped to identify the substances in blood that would allow the isolated heart to beat normally for a time. The original solution of inorganic salts was further modified by Alexis Hartmann for the purpose of treating acidosis
Acidosis
Acidosis is an increased acidity in the blood and other body tissue . If not further qualified, it usually refers to acidity of the blood plasma....

 in children. Hartmann added lactate
Lactate
Lactate may refer to:*The act of lactation*The conjugate base of lactic acid...

, which mitigates changes in pH
PH
In chemistry, pH is a measure of the acidity or basicity of an aqueous solution. Pure water is said to be neutral, with a pH close to 7.0 at . Solutions with a pH less than 7 are said to be acidic and solutions with a pH greater than 7 are basic or alkaline...

 by acting as a buffer
Buffering agent
A buffering agent is a weak acid or base used to maintain the acidity of a solution at a chosen value. The function of a buffering agent is to prevent a rapid change in pH when acids or bases are added to the solution. Buffering agents have variable properties—some are more soluble than others;...

 for acid. Thus the solution became known as 'Lactated Ringer's Solution' or 'Hartmann's solution'.

Therapy

Lactated Ringer's solution is often used for fluid resuscitation after a blood loss due to trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

, surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

, or a burn injury. Previously, it was used to induce urine output in patients with renal failure
Renal failure
Renal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...

.

Another common use is the treatment of renal failure in small animals, where the solution is administered subcutaneously instead of through an IV. Administering the fluids in this way allows the solution to be given to the animal quickly and does not require a vein to be located. The fluid is then slowly absorbed from under the skin into the bloodstream of the animal.

Lactated Ringer's solution is used because the by-products of lactate metabolism in the liver counteract acidosis
Acidosis
Acidosis is an increased acidity in the blood and other body tissue . If not further qualified, it usually refers to acidity of the blood plasma....

, which is a chemical imbalance that occurs with acute fluid loss or renal failure.

The IV dose of lactated Ringer's solution is usually calculated by estimated fluid loss and presumed fluid deficit. For fluid resuscitation the usual rate of administration is 20 to 30 ml/kg body weight/hour. Lactated Ringer's solution is not suitable for maintenance therapy because the sodium content (130 mEq/L) is considered too high, particularly for children, and the potassium content (4 mEq/L) is too low, in view of electrolyte daily requirement.

Other commonly used intravenous fluids include normal saline
Saline (medicine)
In medicine, saline is a general term referring to a sterile solution of sodium chloride in water but is only sterile when it is to be placed intravenously, otherwise, a saline solution is a salt water solution...

 and Hydroxyethyl starch
Hydroxyethyl starch
Hydroxyethyl starch is a nonionic starch derivative. It is one of the most frequently used volume expander under the trade names Hespan by B. Braun Medical Inc...

 solutions (used in hypovolemic shock). Lactated Ringer's and other crystalloids are also used as vehicles for the IV delivery of drugs. Lactated Ringer's is usually given intravenously, but if a suitable vein is not found, it can be taken orally (although it has an unpleasant taste).

See also

  • Intravenous therapy
    Intravenous therapy
    Intravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals...

  • Oral rehydration therapy
    Oral rehydration therapy
    Oral rehydration therapy is a simple treatment for dehydration associated with diarrhoea, particularly gastroenteritis or gastroenteropathy, such as that caused by cholera or rotavirus. ORT consists of a solution of salts and sugars which is taken by mouth...

  • Saline (medicine)
    Saline (medicine)
    In medicine, saline is a general term referring to a sterile solution of sodium chloride in water but is only sterile when it is to be placed intravenously, otherwise, a saline solution is a salt water solution...

  • Hartmann's Solution
    Hartmann's Solution
    Hartmann's solution or compound sodium lactate is a crystalloid solution that is most closely isotonic with blood and intended for intravenous administration.Hartmann's IV Infusion is used toreplace body fluid and mineral salts...

  • Phosphate buffered saline
    Phosphate buffered saline
    Phosphate buffered saline is a buffer solution commonly used in biological research. It is a water-based salt solution containing sodium chloride, sodium phosphate, and, in some formulations, potassium chloride and potassium phosphate. The buffer's phosphate groups help to maintain a constant pH...

    (cell culture)
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