From the Research
Lactated Ringer's (LR) solution does not cause clinically significant elevations in serum lactate levels in most patients. The lactate in LR is metabolized efficiently by the liver, converting it to bicarbonate within 1-2 hours of administration 1. LR contains 28 mEq/L of lactate, which is minimal compared to the body's lactate handling capacity. Even large volumes of LR (multiple liters) typically do not affect lactate measurements meaningfully in patients with normal hepatic function. However, caution may be warranted in patients with severe liver dysfunction who have impaired lactate metabolism. In these cases, alternative crystalloids like normal saline might be preferred if lactate monitoring is critical. It's worth noting that the lactate in LR is the L-isomer, which is physiologically metabolized, unlike the D-isomer found in some other solutions. For practical purposes, clinicians can confidently use LR in most resuscitation scenarios without concern for artificially elevated lactate readings that might confuse clinical assessment.
Some studies have investigated the effect of LR on serum lactate levels. A study published in 2018 found that a bolus of 30 mL/kg of LR increased serum lactate levels by 0.93 mmol/L, but this increase was not statistically significant compared to normal saline 1. Another study published in 2021 found that lactate levels were significantly higher in patients receiving LR compared to acetate Ringer's solution, but this difference was not clinically significant 2.
Key points to consider:
- LR contains 28 mEq/L of lactate, which is minimal compared to the body's lactate handling capacity
- The lactate in LR is metabolized efficiently by the liver, converting it to bicarbonate within 1-2 hours of administration
- Caution may be warranted in patients with severe liver dysfunction who have impaired lactate metabolism
- Alternative crystalloids like normal saline might be preferred if lactate monitoring is critical in patients with severe liver dysfunction
- The lactate in LR is the L-isomer, which is physiologically metabolized, unlike the D-isomer found in some other solutions.
Overall, the current evidence suggests that LR does not cause clinically significant elevations in serum lactate levels in most patients, and it can be used confidently in most resuscitation scenarios without concern for artificially elevated lactate readings 1, 2.