From the Guidelines
Administering a Lactated Ringer's (LR) 250 mL bolus may be appropriate in certain clinical scenarios, such as suspected hypovolemia, poor peripheral perfusion, and end-organ dysfunction, as long as the patient's volume status, vital signs, and contraindications are carefully assessed beforehand. According to the most recent and highest quality study 1, crystalloids, including Lactated Ringer's solution, are recommended for initial resuscitation in critically ill patients. The study suggests that the choice of intravenous fluid should be based on the patient's clinical situation and the characteristics of the fluid.
Some key points to consider when administering a LR bolus include:
- Assessing the patient's volume status and vital signs before administration
- Evaluating for contraindications such as severe heart failure, kidney failure, or hyperkalemia
- Using sterile technique and appropriate tubing
- Monitoring the patient for adverse reactions, including fluid overload
- Following institutional protocols and documenting the intervention appropriately
It is also important to note that the typical adult bolus dose of LR ranges from 250-1000 mL, administered over 15-60 minutes, depending on the clinical situation 1. However, the specific dose and administration rate should be tailored to the individual patient's needs and clinical response.
In the context of the provided scenarios, the Hollenberg guideline recommends 250-500 ml boluses over 15 min titrated to clinical endpoints and cardiac measures of fluid responsiveness 1. This suggests that a 250 mL bolus of LR may be a reasonable initial approach in certain clinical scenarios, as long as the patient is closely monitored and the fluid administration is titrated to their individual response.
From the Research
Administration of Lactated Ringer's (LR) 250 mL Bolus
- The provided studies do not directly address the administration of a Lactated Ringer's (LR) 250 mL bolus in humans.
- However, study 2 suggests that the intravascular volume effect of Ringer's lactate is below 20%, which may be relevant when considering the effectiveness of a bolus.
- Study 3 compares the use of lactated Ringer's solution and 0.9% saline for initial fluid resuscitation in sepsis-induced hypotension, but does not specifically address bolus administration.
- Study 4 discusses the safety of peripheral 3% hypertonic saline bolus administration, but for neurologic emergencies, and may not be directly applicable to the use of LR.
- Study 5 compares the time course of volume expansion during and after infusions of hypertonic saline dextran and lactated Ringer's solution, but does not provide guidance on bolus administration.
- Study 6 examines the effect of intravenous administration of lactated Ringer's solution or hetastarch for the treatment of isoflurane-induced hypotension in dogs, which may not be relevant to human patients.
Key Findings
- The intravascular volume effect of Ringer's lactate is relatively low, as shown in study 2.
- Lactated Ringer's solution may be used for initial fluid resuscitation in sepsis-induced hypotension, as discussed in study 3.
- Peripheral administration of hypertonic saline boluses can be safe, according to study 4.
- The time course of volume expansion during and after infusions of lactated Ringer's solution is an important consideration, as highlighted in study 5.