Lactated Ringer's Solution via Clysis (Hypodermoclysis)
Yes, Lactated Ringer's solution can be administered via clysis (hypodermoclysis) and is actually one of the preferred isotonic crystalloid solutions for this route of administration.
Rationale for LR via Clysis
Lactated Ringer's is a balanced isotonic crystalloid with near-physiological electrolyte composition (osmolarity 273-277 mOsm/L, sodium 130 mmol/L, potassium 4 mmol/L, chloride 108 mmol/L, calcium 0.9 mmol/L, and lactate 27.6 mmol/L), making it well-suited for subcutaneous absorption 1
The balanced electrolyte profile of LR more closely resembles plasma compared to normal saline, which reduces the risk of hyperchloremic metabolic acidosis when larger volumes are administered 1, 2
LR is recommended as a first-line balanced crystalloid for fluid resuscitation in multiple clinical scenarios, including general dehydration, burns, and most hospitalized patients requiring fluid therapy 1, 2
Clinical Advantages for Subcutaneous Administration
The isotonic nature of LR (osmolarity 273-277 mOsm/L) minimizes tissue irritation and promotes better absorption from the subcutaneous space compared to hypertonic solutions 1
LR avoids the complications associated with large volumes of normal saline, including hyperchloremic acidosis, electrolyte derangements, and potential worsening of kidney function 2
The potassium content (4 mmol/L) in LR is physiological and does not create clinically significant hyperkalemia risk in most patients, as demonstrated in large randomized studies involving 30,000 patients 1
Contraindications for LR via Clysis
Avoid LR in patients with severe traumatic brain injury or head trauma due to its slightly hypotonic nature (273-277 mOsm/L vs plasma 275-295 mOsm/L), which can worsen cerebral edema; use 0.9% saline instead in these patients 1
Avoid LR in suspected or proven rhabdomyolysis or crush syndrome due to the risk of hyperkalemia from the potassium content (4 mmol/L) combined with potassium release from damaged muscle tissue 1
Pre-existing severe hyperkalemia (>6.5 mmol/L) is a contraindication for using LR; use potassium-free crystalloid until hyperkalemia resolves 1
Practical Considerations
For pediatric patients, LR is an acceptable isotonic option for subcutaneous hydration, though normal saline is often preferred due to lower cost and wider availability; both are equally effective 3
When using LR for clysis in children, add appropriate dextrose (2.5-5%) to prevent hypoglycemia, particularly in infants and young children 3
Monitor for volume overload carefully, especially in patients with underlying cardiovascular disease, heart failure, or chronic kidney disease 2
Assess renal function, including creatinine and urine output, before initiating LR via clysis in patients with potential kidney issues 1
Common Pitfalls to Avoid
Do not assume the potassium content in LR is contraindicated in mild-to-moderate renal dysfunction—physiologically, it is not possible to create potassium excess using a fluid with potassium concentration equal to or lower than the patient's plasma concentration 1
Do not use LR in anaphylaxis—normal saline is preferred as LR might potentially contribute to metabolic acidosis 3
Ensure proper site selection and rotation for clysis to prevent tissue damage and optimize absorption, regardless of which isotonic solution is chosen