What do I need to know about lactated ringers?

[Bluesaurus]

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Not much on uptodate. What's a good source?

I have some idea that extended use of NS causes electrolyte abnormalities. Also I have some vague idea that lactated ringers may be good for metabolic acidosis. Can anyone fill me in.

 

[lord_jeebus]

1. Grab a bag of LR and check out the list of ingredients. Also note that NS has a higher osmolality.

2. Google "Strong Ion Difference" - the Stewart Acid-Base Model makes it much easier to understand NS-induced metabolic acidosis, but most med students don't learn about it in med school.

 

[jdh71]

Not much on uptodate. What's a good source?

I have some idea that extended use of NS causes electrolyte abnormalities. Also I have some vague idea that lactated ringers may be good for metabolic acidosis. Can anyone fill me in.

What you need to know is that it is NOT NS, which as far as the surgeons is concerned is poison . . . ****ING POISON I TELL YOU!!!11!!one!

LR is more physiologic. And therefore allows you to buff the morning BMP.

 

[jdh71]

1. Grab a bag of LR and check out the list of ingredients. Also note that NS has a higher osmolality.

2. Google "Strong Ion Difference" - the Stewart Acid-Base Model makes it much easier to understand NS-induced metabolic acidosis, but most med students don't learn about it in med school.

I love physical chemical basis for acid base. You understand so many things better than classical acid-base . . . though it doesn't matter as far as treating patients in the real world.

I am not aware of a single study that has been able to demonstrate that an NS induced acidosis contributes to morbidity and/or mortality . . . though I don't spend a lot of time in the surgical lit these days.

 

[Doctor Bob]

What do I need to know about lactated ringers?

You probably already know this, but just in case... one of the common mistakes I see medical students make with regards to LR is thinking that it has glucose in it. An NPO patient needs a glucose source if they're NPO for a long time... LR isn't sufficient. D5LR however...

 

[Rendar5]

Here's the difference: surgical fields use LR. medical fields use NS

 

[PharmaTope]

I love physical chemical basis for acid base. You understand so many things better than classical acid-base . . . though it doesn't matter as far as treating patients in the real world.

I am not aware of a single study that has been able to demonstrate that an NS induced acidosis contributes to morbidity and/or mortality . . . though I don't spend a lot of time in the surgical lit these days.

well i can tell you that a burn patient will already be in a bad state. adding more Chloride will make them more acidotic. lactate ringers would be a more appropriate fluid for that patient.

 

[jdh71]

well i can tell you that a burn patient will already be in a bad state. adding more Chloride will make them more acidotic. lactate ringers would be a more appropriate fluid for that patient.

I understand the intuitive reasons for using LR. I still have never seen a study randomizing the NS to LR that showed it made any difference *in outcomes that matter (morbidity, mortality, length of stay, etc).

We do a lot of things in medicine because we think they make sense, but when studied rigorously turn out to be bull****.

 

[lord_jeebus]

There's a blinded RCT comparing NS and LR for intraop fluids during cadaveric renal transplant. Metabolic acidosis and hyperkalemia seen only in the NS group (something like 20-30% incidence). No difference for postop renal function. It's in one of the anesthesia journals - Anesthesia & Analgesia I think.

I like to cite it when my attendings tell me not to use LR in ESRD out of fear of raising their K.