August 2025
Septic shock: Neonates: IV: 10 or 20 mL/kg; reassess often and repeat as needed (Ref).
Septic shock: Infants, Children, and Adolescents: IV: 10 or 20 mL/kg; reassess often and repeat as needed (Ref).
(For additional information see "Lactated Ringer solution: Drug information")
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.
Diabetic ketoacidosis or hyperosmolar hyperglycemic state, fluid management (off-label use):
Note: Goal of fluid resuscitation is to replace fluid losses, when present, within 24 to 48 hours, with half of fluid losses being replaced within the first 8 to 12 hours (Ref). In patients with chronic kidney disease or congestive heart failure, replace fluids carefully and monitor closely for signs and symptoms of overreplacement (Ref). Refer to institutional protocols.
Initial fluid management: IV: 0.5 to 1 L/hour for 1 to 4 hours (Ref). Note: In patients with hypovolemic shock, more aggressive fluid replacement may be required (Ref). In euvolemic patients (eg, mild diabetic ketoacidosis [DKA]), fluid replacement is less aggressive and is guided by clinical assessment (Ref). If initial serum glucose is <250 mg/dL, initiate dextrose-containing IV fluids when IV insulin is started (Ref).
Subsequent fluid management: IV: Individualize rate of replacement and refer to institutional protocols; an example fluid regimen after initial hydration is 250 to 500 mL/hour. Modify fluid replacement rate based on patient-specific factors (Ref).
Note: Once serum glucose is <250 mg/dL, administer dextrose-containing IV fluids at a reduced rate (eg, 150 to 250 mL/hour) until DKA or hyperosmolar hyperglycemic state has resolved (Ref).
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: Dose dependent on area to be irrigated and the procedure.
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.
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: 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.
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:
Tis-U-Sol: (1000 mL [DSC])
Generic: (1000 mL, 3000 mL, 5000 mL)
Solution, Irrigation [preservative free]:
Generic: (3000 mL)
Yes
IV: For IV use only. Consult individual institutional policies and procedures.
IV: For IV use only. Consult individual institutional policies and procedures.
Irrigation: For irrigation use only.
Store at 20°C to 25°C (68°F to 77°F); brief exposure up to 40°C (104°F) does not adversely affect the product. Avoid excessive heat. Use immediately after opening; do not store for future use. For irrigation, do not warm container over 66°C (150°F).
IV: Source of electrolytes and water for hydration treatment (FDA approved in all ages).
Irrigation: Use as an irrigating fluid for general irrigation, washing, and rinsing (FDA approved in adults).
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 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
Serum electrolytes, calcium, blood glucose, intake and output, weight, acid-base balance, serum osmolarity.
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