What is Lactated Ringer’s Solution & What Can It Treat?

Chances are high that if you have ever been dehydrated, injured or undergone a surgery, you have received Lactated Ringer’s solution. While most people find the name Lactated Ringer’s to be quite odd, the solution is still an important part of medical care and is preferred for the few side effects associated with the solution. Lactated Ringer’s solution was developed in the 1800s by a physician named Sydney Ringer and contained potassium, calcium, chloride, and sodium in water.(5) The solution was then popularly referred to as Ringer’s, after its inventor. Some years later, another physician by the name Alexis Hartmann found that adding lactate to this solution makes it suitable for children.(6) With the addition of lactate to the solution, the name then became Lactate Ringer’s solution. So what exactly is Lactated Ringer’s solution and what can it treat? Let’s take a closer look.

What is Lactated Ringer's Solution?

What is Lactated Ringer’s Solution?

Lactated Ringer’s solution, sometimes simply abbreviated to LR solution, is a type of IV (intravenous) fluid that is given to patients who are having surgery, who are dehydrated or who are receiving IV medications.(7) Lactated Ringer’s solution is also sometimes referred to as sodium lactate solution, Ringer’s or Ringer’s lactate.

There are a wide variety of reasons why you might receive this Lactated Ringer’s IV solution when you are in need of medical care. A sterile solution, Lactated Ringer’s solution is frequently used by doctors for replacing the fluid that is lost from the body. Lactated Ringer’s solution is commonly used in patients who require an aggressive fluid replacement or fluid resuscitation for a particular illness or for blood loss.

Lactated Ringer’s solution looks like water, but it also contains several additives, which include: calcium, potassium, chloride, sodium and lactate.

According to the company that manufactures Lactated Ringer’s solution, B. Braun Medical, every 100 milliliters of the solution includes(1)

  • Water
  • Sodium lactate – 0.31 grams
  • Sodium chloride – 0.6 grams
  • Calcium chloride – 0.02 grams
  • Potassium chloride – 0.03 grams

It is possible that these components vary slightly by the manufacturer to manufacturer.

What is the Use of Lactated Ringer’s Solution?

  • Replacing Lost Fluid: Lactated Ringer’s is typically used for treating or replacing lost blood, fluid or even both(7) Due to the sodium content in Lactated Ringer’s solution, it is usually not utilized for ongoing fluid replacement therapy, but is instead used frequently in situations when large volumes of fluid need to be given. This process is known as fluid resuscitation.
  • Fewer Side Effects: Lactated Ringer’s is also often preferred for use over a normal saline solution because it contains both electrolytes as well as fluid, and is suitable for administering in both children as well as adults. Lactated Ringer’s solution also has far less potential side effects than the normal saline solution(8)
  • Blood Loss, Trauma & Surgery: Lactated Ringer’s solution is given in the treatment of severe trauma, burns, significant blood loss, and severe loss of fluids (usually caused by surgery, dehydration or some other medical problem).
  • For Fluid Maintenance in Patients: Sometimes, small amounts of Lactated Ringer’s solution are also given as maintenance IV. A maintenance IV provides the necessary fluids to a patient who is unable to drink sufficient fluid to regulate and support their normal bodily functions.

Once you receive Lactated Ringer’s solution into your IV, the solution enters the vein and goes not just inside the cells, but also outside the cells. Lactated Ringer’s solution ideally helps achieve or maintain fluid balance in a patient’s body.(2)

Difference Between Lactated Ringer’s and Saline Solution

Lactated Ringer’s and normal saline are two of the most commonly used IV fluids in a healthcare setting and hospitals. Both of them are isotonic fluids, which mean that these fluids have the exact same osmotic pressure as human blood. Osmotic pressure is the measurement of the balance of solutes to solvents. Solutes include calcium, sodium, and chloride, while solvents typically include water.

Being isotonic fluids also mean that when you get Lactated Ringer’s solution intravenously, this solution will not cause the cells to either get bigger or shrink. Instead, though, the Lactated Ringer’s solution will boost the level of fluid volume in your body.

This does not mean that both these solutions are completely the same. Manufacturers of these fluids put just slightly different components into normal saline solution when compared to the Lactated Ringer’s solution. These slight differences mean that the Ringer’s solution does not last for as long inside the body as normal saline does. This is believed to be beneficial in avoiding fluid overload.

Additionally, Lactated Ringer’s solution also contains the additive sodium lactate, which, upon being metabolized by the body, turns into bicarbonate. Bicarbonate is the base that makes the body become less acidic. Due to this reason, some doctors prefer to use Lactated Ringer’s in medical conditions where the body becomes very acidic, such as sepsis.

There are some studies that support the fact that Lactated Ringer’s solution might be preferred for the replacement of lost fluid in trauma patients as compared to using normal saline.(3)

Furthermore, normal saline is also known to have higher chloride content.

The high chloride content can sometimes lead to renal vasoconstriction, which affects the blood flow to the kidneys. However, while this effect is not typically a concern, but it can be dangerous if a patient gets a large dose of normal saline solution.

At the same time, Lactated Ringer’s solution also does not mix too well with some other IV solutions. This is why pharmacies, instead, mix normal saline with other IV solutions, such as:

  • Propranolol
  • Methylprednisolone
  • Norepinephrine
  • Nitroglycerin
  • Nitroprusside

Due to the calcium content in Lactated Ringer’s solution, some doctors do not recommend the use of this solution when a person needs a blood transfusion. This is because the extra calcium could potentially bind with the preservatives in the blood that most blood banks use for storing the blood. This increases the risk of developing blood clots significantly.

Also, Lactated Ringer’s solution is also a little different from what is usually only referred to as Ringer’s solution. Ringer’s solution generally has sodium bicarbonate rather than sodium lactate in it. Ringer’s solution, sometimes, also has more level of glucose (sugar) than what is found in Lactated Ringer’s.(4)

What Can Lactated Ringer’s Treat?

Both children and adults receive Lactated Ringer’s solution. Some of the medical conditions in which this IV solution is known to help include:

  • Treating dehydration.
  • Restoring a patient’s fluid balance after severe burns or significant blood loss.
  • Using to keep a vein open that has an IV catheter.
  • Lactated Ringer’s solution is given during surgery to allow for the flow of IV medications.

Lactated Ringer’s solution is also the IV solution of choice for doctors if the patient has sepsis or infection that is severe enough to throw off the body’s acid-base balance.
Doctors also use Lactated Ringer’s solution as an irrigating substance. Since the solution is sterile, it can be used for washing out a wound. Sterile means that the Lactated Ringer’s solution does not have bacteria in it when it is stored in the proper conditions.

Lactated Ringer’s solution is also used during surgeries for irrigating the surgical site or bladder. Lactated Ringer’s solution helps wash away any bacteria at the surgical site, making it easier for surgeons to see what they are doing.

It is important to remember that manufacturers do not make Lactated Ringer’s solution with the intention of people to drink. It is only and only meant to be used in IV or for irrigation purposes.

Potential Side Effects of Lactated Ringer’s

If a doctor gives too much of Lactated Ringer’s, then it can cause edema and swelling.(7) Some people also have certain medical conditions that render their body unable to handle this extra fluid too well. These medical conditions can include:(7)

If people having any of these medical conditions are given Lactated Ringer’s or any other IV solutions, then doctors need to closely monitor their condition to ensure that they are not getting too much fluid.

Apart from the fluid overload, getting too much of Lactated Ringer’s can also have a direct impact on your electrolyte count, including potassium and sodium. Since there is a less amount of sodium in Lactated Ringer’s than there is in your blood, the body’s sodium levels can become too low if you receive too much of the IV solution.

Conclusion

If you need to have an IV, then you might notice that it says “Lactated Ringer’s” on the IV bag. This solution is a time-tested option when it comes to fluid replacement and doctors all over the world continue to prescribe Lactated Ringer’s solution for various conditions. If you receive Lactated Ringer’s IV solution, then you will continue to be monitored to ensure that you are not getting too much of the solution through your IV.

References:

  1. Singh, S. and Davis, D., 2018. Ringer’s Lactate. In StatPearls [Internet]. StatPearls Publishing.
  2. Dailymed.nlm.nih.gov. (2019). DailyMed – LACTATED RINGERS- sodium chloride, sodium lactate, potassium chloride, and calcium chloride injection, solution. [online] Available at: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d3d29c8f-c326-4097-814a-7f4e08c67068 [Accessed 18 Apr. 2019].
  3. Mane, A.S., 2017. Fluid Resuscitation: Ringer Lactate Versus Normal Saline-A clinical Study. Resuscitation, 1(4), p.7.
  4. Boldt, J., Haisch, G., Suttner, S., Kumle, B. and Schellhase, F., 2002. Are lactated Ringer’s solution and normal saline solution equal with regard to coagulation?. Anesthesia and analgesia, 94(2), pp.378-84.
  5. https://www.researchgate.net/publication/8903217_Sydney_Ringer_physiological_saline_calcium_and_the_contraction_of_the_heart
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479318/
  7. https://www.ncbi.nlm.nih.gov/books/NBK500033/
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394148/

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