From the Guidelines
Sodium levels in Lactated Ringer's (LR) solution are significant as they contribute to the fluid's near-isotonic properties, making it suitable for intravenous fluid replacement in clinical settings, but its use should be cautious in patients with severe liver disease, hyperkalemia, or hypercalcemia, as well as those requiring sodium restriction or at risk of fluid overload 1. The concentration of sodium in LR solution is 130 mEq/L, which is slightly lower than the normal serum sodium concentration in humans (135-145 mEq/L) 1. This makes LR a commonly used fluid for intravenous fluid replacement in clinical settings, such as in patients with hypovolemia, burns, or trauma. Key considerations for the use of LR solution include:
- Its near-isotonic properties, which make it suitable for fluid resuscitation
- The presence of other electrolytes, including potassium (4 mEq/L), calcium (2.7 mEq/L), chloride (109 mEq/L), and lactate (28 mEq/L)
- The lactate in the solution, which is metabolized by the liver to bicarbonate, providing a mild buffering effect that helps correct metabolic acidosis
- The need for cautious use in patients with severe liver disease, hyperkalemia, or hypercalcemia, as well as those requiring sodium restriction or at risk of fluid overload, such as those with severe heart failure or kidney disease 1.
From the Research
Significance of Sodium Levels in Lactated Ringer's Solution
- The standard lactated Ringer's solution contains sodium at a concentration of 130 mEq/L, which is close to the normal plasma sodium concentration 2.
- Sodium levels in Lactated Ringer's solution are important for maintaining buffering capacity in body fluids, as shown in a study where Ringer's solutions containing no lactate, sodium L-lactate, or racemic lactate at a concentration of 84 mEq/L were infused in patients under general anesthesia 2.
- The use of Lactated Ringer's solution with sodium has been associated with improved outcomes in certain patient populations, such as those with acute pancreatitis, where it was found to be associated with lower 1-year mortality compared to normal saline 3.
- However, the significance of sodium levels in Lactated Ringer's solution may vary depending on the specific patient population and clinical context, as shown in a study where the use of Lactated Ringer's solution was not found to be associated with improved outcomes in patients undergoing elective orthopedic and colorectal surgery 4.
- In patients with traumatic brain injury, the use of Lactated Ringer's solution with sodium has been associated with increased mortality compared to normal saline, highlighting the need for careful consideration of fluid management in this patient population 5.
- The optimal sodium concentration in Lactated Ringer's solution for specific patient populations, such as children with severe head injury, is still a topic of debate, with some studies suggesting that hypertonic saline may be superior to lactated Ringer's solution in this context 6.