From the Guidelines
Lactated Ringer's solution does not significantly affect serum lactate levels in most patients with normal hepatic function. The lactate in Lactated Ringer's solution is metabolized efficiently by the liver, converting it to bicarbonate within a short period of administration 1. This metabolism occurs rapidly enough that even large volumes of Lactated Ringer's solution rarely cause clinically significant elevations in serum lactate levels in patients with normal liver function.
Key Considerations
- The liver's ability to metabolize lactate from Lactated Ringer's solution is crucial, and patients with severe hepatic dysfunction may have impaired lactate clearance.
- Alternative crystalloids like normal saline might be preferred in cases where lactate monitoring is critical for clinical decision-making, especially in patients with severe hepatic dysfunction.
- The lactate in Lactated Ringer's is the L-isomer (L-lactate), which is the physiologically active form that the body metabolizes naturally.
Clinical Implications
- The transient and minimal increase in serum lactate from Lactated Ringer's is unlikely to interfere with lactate as a marker of tissue hypoperfusion in most clinical scenarios.
- Current evidence does not support a clear benefit of Ringer’s lactate solution compared to normal saline for important outcomes, such as organ failure, necrosis, or mortality 1.
- Goal-directed fluid resuscitation is beneficial, but the optimal fluid therapy practice in acute conditions, such as acute pancreatitis, requires further research 1.
From the Research
Effect of Lactated Ringer's Solution on Serum Lactate Levels
- The study published in 1997 2 found that the short-term infusion of lactated Ringer's solution in normal adults does not falsely increase circulating lactate concentrations when 1 L is given over 1 hour.
- A 2018 study 3 discovered that after a 30 mL/kg bolus of lactated Ringer's solution, the mean serum lactate level increased by 0.93 mmol/L, but there was no statistically significant difference in the change in lactate when comparing the lactated Ringer's solution group to the normal saline group.
- Another study from 2016 4 found that fluid type had no effect on admission biochemical or physiological parameters, including lactate levels, in patients with traumatic brain injury.
- A review published in 2017 5 discussed the metabolism of lactate and the pathophysiology of lactic acidosis, but did not specifically address the effect of lactated Ringer's solution on serum lactate levels.
- A 2025 study 6 compared lactated Ringer's solution to normal saline for initial fluid resuscitation in sepsis-induced hypotension, and found that patients receiving lactated Ringer's solution had improved survival, but did not specifically report on the effect of lactated Ringer's solution on serum lactate levels.
Key Findings
- Lactated Ringer's solution may not significantly increase serum lactate levels in healthy individuals or patients with traumatic brain injury 2, 3, 4.
- The effect of lactated Ringer's solution on serum lactate levels may depend on the specific patient population and clinical context 3, 6.
- Further research is needed to fully understand the relationship between lactated Ringer's solution and serum lactate levels in different clinical scenarios 2, 3, 4, 5, 6.