How to order hypertonic lactate solution (HLS) for treatment?

From the Guidelines

To order hypertonic lactate solution, contact your hospital pharmacy and request Lactated Ringer's solution with additional sodium lactate to achieve the desired hypertonicity, typically containing 1.3% to 3% sodium lactate, as recommended by recent guidelines 1. When ordering, specify the concentration needed, commonly 1.3% for mild hypertonicity or 3% for more significant osmotic effect, and the volume required, usually available in 500mL or 1000mL bags.

• The pharmacy will need to compound this as it's not typically commercially available as a premixed solution.
• Include the patient's diagnosis, indication for hypertonic therapy, and any specific infusion rate requirements.
• Hypertonic lactate solutions work by creating an osmotic gradient that draws fluid from edematous tissues into the intravascular space, while the lactate serves as a metabolizable anion that converts to bicarbonate, potentially helping correct metabolic acidosis.
• These solutions are particularly useful in traumatic brain injury, cerebral edema, or situations requiring osmotherapy with metabolic support, as suggested by the Surviving Sepsis Campaign guidelines 1. The most recent guidelines from 2016, as published in Critical Care Medicine and Intensive Care Medicine 1, emphasize the importance of early and effective fluid resuscitation in sepsis-induced hypoperfusion, but do not specifically address the use of hypertonic lactate solutions. However, based on the principles of fluid resuscitation and the properties of hypertonic lactate solutions, the recommended approach is to use hypertonic lactate solutions in specific clinical scenarios where their benefits can be maximized, such as in traumatic brain injury or cerebral edema, while closely monitoring the patient's hemodynamic status and adjusting the treatment as needed 1.

From the Research

Ordering Hypertonic Lactate Solution (HLS) for Treatment

To order hypertonic lactate solution (HLS) for treatment, consider the following:

• The composition of the solution: Hypertonic lactated saline solution has been used for resuscitation in various studies 2, 3, 4.
• The volume and rate of administration: Studies have shown that small-volume resuscitation using hypertonic solutions can be effective 5, 6.
• The patient's condition: HLS has been used in patients with severe burns 4, traumatic injury 6, and acute hemorrhage 3.
• The comparison with other fluids: HLS has been compared with other fluids such as lactated Ringer's solution 4, 0.9% NaCl 2, and hypertonic sodium-bicarbonate 2.

Key Considerations

• The benefits of hypertonic solutions include increased intravascular volume, improved cardiac function, and positive effects on the microvasculature and immune system 5.
• The choice of fluid may depend on the patient's specific needs and the desired outcome, such as lactate clearance 6 or correction of metabolic acidosis 6.
• The potential risks and complications of hypertonic solutions, such as fluid overload and abnormal serum sodium levels, should be considered 6.

Administration Guidelines

• The administration of HLS may involve a small-volume bolus over a few minutes 5.
• The volume of fluid administered may be lower than with isotonic crystalloids 3, 4.
• The solution may be used in conjunction with other treatments, such as operative intervention 6.