From the Guidelines
Ringer's lactate is the preferred choice for intravenous fluid replacement in critically ill patients, including those with acute pancreatitis, due to its balanced composition and potential anti-inflammatory effects, as suggested by recent guidelines and studies 1.
Key Characteristics of Ringer's Lactate
- Isotonic crystalloid fluid used for intravenous fluid replacement
- Contains sodium chloride, potassium chloride, calcium chloride, and sodium lactate in water
- Similar in composition to extracellular fluid
- Typical administration rate varies based on clinical need, ranging from maintenance rates of 1-2 mL/kg/hr to bolus infusions of 20 mL/kg for resuscitation in hypovolemic states
Clinical Uses of Ringer's Lactate
- Situations involving fluid loss, such as dehydration, burns, trauma, surgery, and sepsis
- Expands intravascular volume while providing essential electrolytes
- Lactate component is metabolized by the liver to bicarbonate, making it beneficial in mild metabolic acidosis
Important Considerations
- Use cautiously in patients with severe liver disease, as they may not effectively metabolize lactate
- Calcium content makes it incompatible with certain medications, particularly blood products containing citrate anticoagulants, as calcium can promote clotting
- Recent studies suggest that Ringer's lactate may be associated with reduced mortality and improved outcomes in critically ill patients, including those with acute pancreatitis 1
- Guidelines recommend the use of balanced crystalloids, such as Ringer's lactate, over non-balanced crystalloids, such as 0.9% NaCl, in critically ill patients 1
From the Research
Ringer Lactate Overview
- Ringer lactate, also known as lactated Ringer's solution, is a type of fluid resuscitation used in medical settings to treat various conditions, including sepsis-induced hypotension, acute pancreatitis, and uncontrolled hemorrhagic shock.
- The solution is designed to mimic the electrolyte composition of human blood and is often used as an alternative to normal saline.
Clinical Outcomes
- A study published in 2025 2 found that initial fluid resuscitation with lactated Ringer's solution, compared with 0.9% saline, might be associated with improved survival in patients with sepsis-induced hypotension.
- Another study published in 2024 3 found that patients receiving Plasma-Lyte had longer hospital and SICU lengths of stay compared to those receiving lactated Ringer's solution, although there was no difference in in-hospital mortality.
- A study published in 2020 4 found that the alkalinizing effect of Plasmalyte was less important than expected, with no difference in base excess compared with Ringer lactate, in part due to gluconate accumulation.
- A study published in 2018 5 found that lactated Ringer's solution was superior to normal saline in reducing systemic inflammatory response syndrome (SIRS) in acute pancreatitis only in the first 24 hours.
- A study published in 2006 6 found that resuscitation with lactated Ringer's solution led to greater hypercoagulability and less blood loss than resuscitation with normal saline in uncontrolled hemorrhagic shock.
Comparison with Other Fluids
- Lactated Ringer's solution has been compared with other fluids, including normal saline and Plasma-Lyte, in various studies.
- The choice of fluid resuscitation may depend on the specific clinical context and the patient's individual needs.
- Further research is needed to determine the optimal fluid resuscitation strategy for different patient populations and clinical conditions.