Lactated Ringers (LR) vs Normal Saline (NS) - Comparison Composition of LR: • Sodium 130 mEq/L • Potassium 4 mEq/L • Calcium 1.5 mEq/L • Chloride 109 mEq/L • Sodium lactate 28 mEq/L • Osmolarity of 273 mOsmol/L • pH of 6.5 • Caloric content of 9 kcal/L Composition of NS: • Sodium 154 mEq/L • Chloride 154 mEq/L • Osmolarity 308 mOsmol/L • pH of 4-7.5 Lactated Ringers (LR) • pH 6.5 • SMART/SALT-ED trial • Minimal K - 4 mEq • Sodium Lactate: 28 mole/L of sodium lactate NOT lactic acid • LR Contains Calcium: - Can give with blood but not in same line - Citrate in blood can precipitate with calcium causing clotting • Higher pH: - Less development of metabolic acidosis - Protective effects with less inflammation and necrosis in states such as acute pancreatitis Normal Saline (NS) Is Not Normal! • pH 4 to 7.5 • Saline Exacerbates Acidosis: - Hyperchloremia nonanion gap metabolic acidosis • Saline Is Dangerous in Hyperkalemia: - Acidosis worsening transcellular shift • Saline Causes AKI: - Tubuloglomerular feedback: Macula densa receives high chloride load - signal to reduce GFR to reduce chloride filtration - Renal edema and capsular stretch - decreased renal blood flow and renal tissue perfusion - Decreased GFR, urine volume and sodium excretion • Saline May Cause Hemodynamic Instability: - Renal vasoconstriction and vasodilation - Acidosis worsens cardiac contractility • Saline Increases Levels of Inflammation • Increases Edema: - Increases vascular permeability and vasodilation - Damage to endothelial glycocalyx - increases interstitial volume - increased edema • Coagulopathy: - Dilutes clotting factors - impair coagulation and hemostasis: - Iatrogenic coagulopathy - functional impairment of thrombin and fibrin - Also can disrupt and destroy existing clots #Lactated #Ringers #LR #Normal #Saline #NS #comparison #pharmacology #effects
