Version May 2024
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): Note: Balanced crystalloids may be preferred over normal saline; however, fluid therapy should be individualized (Ref).
IV: Initial resuscitation: Minimum of 30 mL/kg to be given within the first 3 hours for shock or hypoperfusion. Administer vasopressors during or after fluid resuscitation to maintain a mean arterial pressure ≥65 mm Hg; following initial resuscitation, additional fluid administration guided by frequent reassessment of hemodynamic status may be necessary (Ref). Note: Some patients may require more rapid administration and/or greater amount of fluid for complete initial resuscitation (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
(For additional information see "Lactated Ringer solution: Pediatric drug information")
Septic shock: Infants, Children, and Adolescents: IV: 10 or 20 mL/kg; reassess often and repeat as needed (Ref).
The following adverse drug reactions are derived from product labeling unless otherwise specified.
Postmarketing: Hypersensitivity: Hypersensitivity reaction, nonimmune anaphylaxis
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.
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 kidney 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 kidney 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.
• Kidney 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.
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)
Yes
IV: For IV use only. Consult individual institutional policies and procedures.
Irrigation: For irrigation use only.
IV: For IV use only. Consult individual institutional policies and procedures.
Injection:
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
None known.
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 Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Alpha-/Beta-Agonists (Indirect-Acting): Alkalinizing Agents may increase the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting). Risk C: Monitor therapy
Amantadine: Alkalinizing Agents may increase the serum concentration of Amantadine. Risk C: Monitor therapy
Amphetamines: Alkalinizing Agents may decrease the 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 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
Flecainide: Alkalinizing Agents may decrease the excretion of Flecainide. Risk C: Monitor therapy
Mecamylamine: Alkalinizing Agents may increase the serum concentration of Mecamylamine. Risk C: Monitor therapy
Memantine: Alkalinizing Agents may increase the serum concentration of Memantine. Risk C: Monitor therapy
QuiNIDine: Alkalinizing Agents may increase the serum concentration of QuiNIDine. Risk C: Monitor therapy
QuiNINE: Alkalinizing Agents may increase the serum concentration of QuiNINE. Risk C: Monitor therapy
Serum sodium, potassium, chloride, calcium, bicarbonate concentrations, acid-base balance, and osmolarity; I & O, weight. Monitor infusion site.
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