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Lactated Ringer solution: Drug information

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

For abbreviations, symbols, and age group definitions show table
Pharmacologic Category
  • Electrolyte Supplement, Parenteral
Dosing: Adult
Alkalinizing agent, replacement

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.

Hypovolemia, general ICU

Hypovolemia, general ICU:

Note: Balanced crystalloids are preferred over saline for most patients (Ref). Fluids should be administered only if volume resuscitation is needed (Ref). Optimal dose has not been standardized; rate of repletion depends on underlying etiology, fluid loss, total body deficit, and electrolyte status (Ref).

IV: Initial: 4 mL/kg or 250 to 500 mL (Ref); administer additional fluid in 250 to 500 mL increments, as needed. Recommended fluid intake from all fluid sources (eg, nutrition, medications, blood products): 25 to 30 mL/kg/day. The decision to provide more liberal volume resuscitation should be individualized (Ref).

Irrigation

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

Septic shock, fluid resuscitation

Septic shock, fluid resuscitation (off-label use): Note: Balanced crystalloids may be preferred over normal saline; however, fluid therapy should be individualized (Ref).

IV: Initial: ~30 mL/kg typically within the first 3 hours. Administer vasopressors during or after fluid resuscitation to maintain a mean arterial pressure ≥65 mm Hg; additional fluid administration guided by frequent reassessment of hemodynamic status may be necessary (Ref).

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

Dosing: Pediatric

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

Septic shock

Septic shock: Infants, Children, and Adolescents: IV: 10 or 20 mL/kg; reassess often and repeat as needed (Ref).

Adverse Reactions

The following adverse drug reactions are derived from product labeling unless otherwise specified.

Postmarketing: Hypersensitivity: Hypersensitivity reaction, nonimmune anaphylaxis

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.

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

Warnings/Precautions

Disease-related concerns:

• Alkalosis: Use with caution in patients with alkalosis or at risk for alkalosis. Lactate is metabolized to bicarbonate and could worsen metabolic alkalosis.

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

• Fluid overload: Use with extreme caution, if at all, in patients with hypervolemia, overhydration, edema, or conditions that may cause sodium and/or fluid overload.

• Heart failure: Use with caution in patients with heart failure.

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

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

• Kidney impairment: Use with caution in patients with severe renal insufficiency.

Special populations:

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

Other warnings/precautions:

• Appropriate use:

- Injection: 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.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

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, 3000 mL, 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.

Administration: Pediatric

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

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

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Amantadine: Alkalinizing Agents may increase serum concentration of Amantadine. Risk C: Monitor

Amphetamines: Alkalinizing Agents may decrease excretion of Amphetamines. Management: Consider alternatives to using amphetamines and alkalinizing agents in combination. If these agents must be used together, patients should be monitored closely for excessive amphetamine effects. Risk D: Consider Therapy Modification

CefTRIAXone: Ringer's Injection (Lactated) may increase adverse/toxic effects 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

Flecainide: Alkalinizing Agents may decrease excretion of Flecainide. Risk C: Monitor

Mecamylamine: Alkalinizing Agents may increase serum concentration of Mecamylamine. Risk C: Monitor

Memantine: Alkalinizing Agents may increase serum concentration of Memantine. Risk C: Monitor

QuiNIDine: Alkalinizing Agents may increase serum concentration of QuiNIDine. Risk C: Monitor

QuiNINE: Alkalinizing Agents may increase serum concentration of QuiNINE. Risk C: Monitor

Monitoring Parameters

Complete metabolic panel; hemodynamics; volume status; fluid responsiveness (dynamic measures preferred). Monitor infusion site.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AR) Argentina: Solucion de ringer con lactato;
  • (AU) Australia: Baxter compound sodium lactate | Compound sodium lactate (hartmann's solution);
  • (BD) Bangladesh: Hartsol | Lactoring;
  • (BE) Belgium: Hartmann;
  • (BG) Bulgaria: Hartmann;
  • (BR) Brazil: Baxter solucao de ringer com lactato | Ringer com lactato | Ringer com lactato de sodio | Solucion ringer lactato;
  • (CI) Côte d'Ivoire: Infusan Rl;
  • (CN) China: Sodium lactate ringer's;
  • (CO) Colombia: Solucion de lactato de ringer | Solucion de ringer con lactato;
  • (DE) Germany: Ringer lactat demo;
  • (EC) Ecuador: Compuesto de lactato de sodio;
  • (ES) Spain: Apiros ringer lactato;
  • (ET) Ethiopia: Compound sodium lactate;
  • (GB) United Kingdom: Freeflex hartmanns;
  • (ID) Indonesia: Fima Rl | Infusan Rl | Wida Rl;
  • (IE) Ireland: Compound sodium lactate;
  • (IN) India: Compound sodium lactate;
  • (JP) Japan: Hartmann's solution np | Hartmann's solution pH 8 np | Nisori;
  • (KE) Kenya: Compound sodium lactate | Infusol hm;
  • (KR) Korea, Republic of: Hartman | Hartmann soln | Hartmann's;
  • (MX) Mexico: Delmed solucion hartmann | Harrenic;
  • (MY) Malaysia: Infusol hm;
  • (NG) Nigeria: Unihart;
  • (NZ) New Zealand: Compound sodium lactate Hartmanns;
  • (PK) Pakistan: Macsolate | Searle rl | Visolact;
  • (PL) Poland: Solutio Ringeri Lactate;
  • (PY) Paraguay: Solucion de ringer con lactato b braun | Solucion de ringer con lactato baxter | Solucion fisiologica de ringer con lactato;
  • (QA) Qatar: Aarel;
  • (RU) Russian Federation: Hartmans solution | Ringer lactate viaflo;
  • (SL) Sierra Leone: Compound sodium lactate;
  • (SR) Suriname: Compound sodium lactate | Hartman | Ringer lactate;
  • (TR) Turkey: Lafleks laktatli ringer | Laktatli ringer | NEOFLEKS LAKTATLI RINGER;
  • (TW) Taiwan: Hartmann's | Nisori;
  • (UG) Uganda: Compound sodium lactate | Compound sodium lactate bp;
  • (ZA) South Africa: Sabax ringer lactate;
  • (ZM) Zambia: Sabax ringer lactate;
  • (ZW) Zimbabwe: Compound sodium lactate
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  6. Lactated Ringer's Irrigation [prescribing information]. Bethlehem, PA: B. Braun Medical Inc; August 2018.
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