From the Guidelines
Ringer's lactate should be administered at 30 mL/kg of IV crystalloid fluid within the first 3 hours for resuscitation from sepsis-induced hypoperfusion, as recommended by the Surviving Sepsis Campaign guidelines 1.
Key Points
- The initial fluid resuscitation should begin with at least 30 mL/kg of IV crystalloid fluid within the first 3 hours, as recommended by the Surviving Sepsis Campaign guidelines 1.
- Following initial fluid resuscitation, additional fluids should be guided by frequent reassessment of hemodynamic status, including a thorough clinical examination and evaluation of available physiologic variables 1.
- Ringer's lactate is a balanced crystalloid solution that can be used for resuscitation, but its use should be cautious in patients with severe liver dysfunction, hyperkalemia, or hypercalcemia.
- Blood pressure, heart rate, urine output, mental status, and laboratory values should be monitored to assess the effectiveness of resuscitation and guide ongoing fluid therapy.
Rationale
The Surviving Sepsis Campaign guidelines recommend early effective fluid resuscitation for stabilization of sepsis-induced tissue hypoperfusion or septic shock 1. The guidelines suggest that dynamic over static variables be used to predict fluid responsiveness, where available, and recommend an initial target mean arterial pressure of 65 mm Hg in patients with septic shock requiring vasopressors 1.
Considerations
- The use of Ringer's lactate should be individualized based on the patient's clinical condition and response to therapy.
- The guidelines recommend guiding resuscitation to normalize lactate in patients with elevated lactate levels as a marker of tissue hypoperfusion, but this is a weak recommendation with low quality of evidence 1.
- Further hemodynamic assessment, such as assessing cardiac function, should be performed to determine the type of shock if the clinical examination does not lead to a clear diagnosis 1.
From the Research
Ringer Lactate in Resuscitation
- Ringer lactate is a type of crystalloid fluid used in resuscitation, particularly in cases of hemorrhagic shock, sepsis, and acute diabetic ketoacidosis.
- Studies have compared the effectiveness of Ringer lactate with other fluids, such as normal saline, in various clinical settings.
Comparison with Normal Saline
- 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 lactated Ringer's was associated with faster time to high anion gap metabolic acidosis resolution compared to normal saline in patients with acute diabetic ketoacidosis.
- However, a retrospective analysis published in 2023 4 found no significant difference in mortality rates, hospital length of stay, or ICU admission between sepsis patients receiving lactated Ringer's and normal saline as predominant resuscitation fluid.
Clinical Outcomes
- A study published in 2022 5 found that bicarbonated Ringer's solution, which provides physiological levels of bicarbonate ions and electrolyte ions, can be used to supplement missing extracellular fluid and correct metabolic acidosis in patients with traumatic hepatic rupture and hemorrhagic shock.
- A study published in 2016 6 found that hospital mortality was lower in patients with acute pancreatitis who received lactated Ringer's compared to those who received isotonic saline.
Inflammatory Factors
- The study published in 2022 5 found that the levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-α in the bicarbonated Ringer's group were significantly lower 1 hour following resuscitation than prior to resuscitation.
- The study published in 2025 2 found that treatment with 0.9% saline was associated with higher levels of serum chloride and decreased levels of serum bicarbonate.