From the Guidelines
Lactated Ringer's (LR) fluids should be administered for at least 12-24 hours in patients with acute pancreatitis, as recommended by the American College of Gastroenterology (ACG) guidelines 1. The duration of LR fluid administration can vary depending on the patient's clinical condition and needs. For example, in patients with severe acute pancreatitis, the Italian Association for the Study of the Pancreas (AISP) suggests early aggressive hydration at 2 ml/kg/h, with an initial bolus of 20 ml/kg within 30-45 min in the first 24 h 1. Some key points to consider when administering LR fluids include:
- The administration rate, which commonly ranges from 1-4 mL/kg/hour for maintenance to 20-30 mL/kg over 1-2 hours for resuscitation 1
- Regular assessments of vital signs, urine output, electrolyte levels, and overall clinical status to adjust the duration and rate of LR fluid administration
- Monitoring for fluid overload, especially in patients with cardiac, renal, or hepatic impairment 1 It's essential to note that the guidelines for the design of fluid resuscitation protocols remain inconsistent, and the optimal initial rate of fluid resuscitation in acute pancreatitis is still a topic of debate 1. However, the most recent and highest-quality study suggests that aggressive intravenous hydration may increase the risk of fluid overload and mortality in patients with non-severe acute pancreatitis 1.
From the Research
Administration Duration of Lactated Ringer's (LR) Fluids
The administration duration of Lactated Ringer's (LR) fluids can vary depending on the specific medical context and patient needs. Here are some key points to consider:
- In a study published in 1997 2, LR fluids were administered for 1 hour to healthy adult volunteers, with no significant increase in circulating lactate concentrations observed.
- Another study from 2016 3 compared the effects of pre-hospital administration of LR versus normal saline in patients with traumatic brain injury, but did not specify the exact duration of LR administration.
- A 2018 study 4 on fluid resuscitation with LR versus normal saline in acute pancreatitis did not provide information on the administration duration of LR fluids.
- In a 2014 study 5 comparing the effects of albumin, hydroxyethyl starch, and Ringer's lactate on blood loss and coagulation after cardiac surgery, the administration duration of LR fluids was not specified.
- A 2021 study 6 compared the effects of Ringer's lactate and 6% hydroxyethyl starch 130/0.4 on blood loss and need for blood transfusion after off-pump coronary artery bypass graft cardiac surgery, with LR administered at a rate of 20 ml/kg during the surgery, but the exact administration duration was not provided.
Key Findings
Some key findings related to the administration of LR fluids include:
- LR fluids can be administered for short periods (e.g., 1 hour) without significant increases in circulating lactate concentrations 2.
- The choice of fluid (LR versus normal saline) may affect patient outcomes in certain contexts, such as traumatic brain injury 3 or acute pancreatitis 4.
- LR fluids may be associated with less blood loss and transfusion requirements compared to colloids in certain surgical contexts 5, 6.