From the Guidelines
Lactated Ringer's is generally preferred over normal saline for most fluid resuscitation scenarios, including severe dehydration, shock, or altered mental status, as it more closely resembles plasma composition and causes less acid-base disturbance 1. When deciding between normal saline and lactated Ringer's, it's essential to consider the patient's specific clinical condition, underlying electrolyte abnormalities, and the purpose of fluid administration.
- Normal saline is preferred for patients with metabolic alkalosis, severe hypercalcemia, or hyponatremia, and when administering blood products or certain medications like amphotericin B.
- Lactated Ringer's is contraindicated in patients with severe hyperkalemia, liver failure, or when administering blood products due to potential calcium-induced clotting.
- For prolonged or large volume resuscitation, lactated Ringer's is typically better tolerated than normal saline because it causes less acid-base disturbance 1.
- The choice between these fluids should be based on the patient's specific clinical condition, underlying electrolyte abnormalities, and the purpose of fluid administration, with a focus on minimizing morbidity, mortality, and improving quality of life 1.
From the Research
Normal Saline vs Lactated Ringers
- The choice between normal saline and lactated Ringers for fluid resuscitation depends on the patient's condition and the specific clinical scenario 2, 3, 4, 5, 6.
- In patients with sepsis, balanced crystalloids such as lactated Ringers may be a safer alternative to normal saline due to the potential for increased mortality and kidney injury associated with normal saline 2.
- In trauma patients, outcomes are not significantly different between normal saline and lactated Ringers, except in patients with traumatic brain injury, where normal saline may be preferred 3, 5.
- In cases of massive hemorrhage and resuscitation, lactated Ringers may be superior to normal saline due to its ability to reduce acidosis and improve survival 6.
- The use of albumin and hypertonic saline as adjuncts to fluid therapy may be beneficial in certain situations, but their use is not without controversy and should be considered on a case-by-case basis 3, 4.
Specific Clinical Scenarios
- Traumatic Brain Injury: Normal saline may be preferred over lactated Ringers in patients with traumatic brain injury due to its potential to reduce mortality 5.
- Sepsis: Balanced crystalloids such as lactated Ringers may be a safer alternative to normal saline due to the potential for increased mortality and kidney injury associated with normal saline 2.
- Massive Hemorrhage and Resuscitation: Lactated Ringers may be superior to normal saline due to its ability to reduce acidosis and improve survival 6.