LACTATED RINGERS- sodium chloride, sodium lactate, potassium chloride and calcium chloride injection, solution
Becton Dickinson and Company
in free –flex ® Bag
Lactated Ringer’s Injection, USP is a sterile, nonpyrogenic solution for fluid and electrolyte replenishment in single dose containers for intravenous administration. It contains no antimicrobial agents. Composition, osmolarity, pH, ionic concentration and caloric content are shown in Table 1.
|Size (mL)||Composition (g/L)||Ionic Composition (mEq/L)||Caloric Content (kcal/L)|
|Sodium Chloride, USP (NaCl)||Sodium Lactate, USP (C3 H5 NaO3 )||Potassium Chloride, USP (KCl)||Calcium Chloride, USP (CaCl2 •2H2 O)||Osmolarity (mOsmol/L) (calc)||pH||Sodium||Potassium||Calcium||Chloride||Lactate|
|Lactated Ringer’s Injection, USP||250||6||3.1||0.3||0.2||273||6.5 (6.0 to 7.5)||130||4||2.7||109||28||9|
The flexible container is fabricated from a specially formulated non-plasticized, film containing polypropylene and thermoplastic elastomers (free flex ® bag). The amount of water that can permeate from inside the container into the overwrap is insufficient to affect the solution significantly. Solutions in contact with the flexible container can leach out certain of the container’s chemical components in very small amounts within the expiration period. The suitability of the container material has been confirmed by tests in animals according to USP biological tests for plastic containers.
Lactated Ringer’s Injection has value as a source of water and electrolytes. It is capable of inducing diuresis depending on the clinical condition of the patient.
Lactated Ringer’s Injection produces a metabolic alkalinizing effect. Lactate ions are metabolized ultimately to carbon dioxide and water, which requires the consumption of hydrogen cations.
Lactated Ringer’s Injection is indicated as a source of water and electrolytes or as an alkalinizing agent.
As for other calcium-containing infusion solutions, concomitant administration of ceftriaxone and Lactated Ringer’s Injection is contraindicated in newborns (≤ 28 days of age), even if separate infusion lines are used (risk of fatal ceftriaxone-calcium salt precipitation in the neonate’s bloodstream).
In patients older than 28 days (including adults), ceftriaxone must not be administered simultaneously with intravenous calcium-containing solutions, including Lactated Ringer’s Injection, through the same infusion line (e.g., via Y-connector). If the same infusion line is used for sequential administration, the line must be thoroughly flushed between infusions with a compatible fluid.
Lactated Ringer’s Injection is contraindicated in patients with a known hypersensitivity to sodium lactate.
Although Lactated Ringer’s Injection has a potassium concentration similar to the concentration in plasma, it is insufficient to produce a useful effect in case of severe potassium deficiency; therefore, it should not be used for this purpose.
Lactated Ringer’s Injection is not for use for the treatment of lactic acidosis or severe metabolic acidosis.
Lactated Ringer’s Injection should not be administered simultaneously with citrate anticoagulated/preserved blood through the same administration set because of the likelihood of coagulation.
The infusion must be stopped immediately if any signs or symptoms of a suspected hypersensitivity reaction develop. Appropriate therapeutic countermeasures must be instituted as clinically indicated. Hypersensitivity reactions are reported more frequently during pregnancy.
Depending on the volume and the rate of infusion, the intravenous administration of Lactated Ringer’s Injection can cause fluid and/or solute overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states, pulmonary edema or acid-base imbalance. The risk of dilutional states is inversely proportional to the electrolyte concentrations of the injections. The risk of solute overload causing congested states with peripheral and pulmonary edema is directly proportional to the electrolyte concentrations of the injections.
Clinical evaluation and periodic laboratory determinations may be necessary to monitor changes in fluid balance, electrolyte concentrations, and acid base balance during prolonged parenteral therapy or whenever the condition of the patient or the rate of administration warrants such evaluation.
Lactated Ringer’s Injection should be administered with particular caution, if at all, to patients with hyperkalemia or conditions predisposing to hyperkalemia (such as severe renal impairment or adrenocortical insufficiency, acute dehydration, or extensive tissue injury or burns) and in patients with cardiac disease.
Lactated Ringer’s Injection should be administered with particular caution, if at all, to patients with alkalosis or at risk for alkalosis. Because lactate is metabolized to bicarbonate, administration may result in, or worsen, metabolic alkalosis.
Lactated Ringer’s Injection should be administered with particular caution, if at all, to patients with severe renal impairment, hypervolemia, overhydration, or conditions that may cause sodium and/or potassium retention, fluid overload, or edema.
Do not connect flexible plastic containers in series in order to avoid air embolism due to possible residual air contained in the primary container.
Pressurizing intravenous solutions contained in flexible plastic containers to increase flow rates can result in air embolism if the residual air in the container is not fully evacuated prior to administration.
Use of a vented intravenous administration set with the vent in the open position could result in air embolism. Vented intravenous administration sets with the vent in the open position should not be used with flexible plastic containers.
Lactated Ringer’s Injection should be administered with particular caution, if at all, to patients with conditions associated with increased lactate levels or impaired lactate utilization, such as severe hepatic insufficiency.
Hyperlactatemia can develop in patients with severe hepatic insufficiency, since lactate metabolism may be impaired. In addition, Lactated Ringer’s Injection may not produce its alkalinizing action in patients with severe hepatic insufficiency, since lactate metabolism may be impaired.
Solutions containing calcium salts should be used with caution in patients with hypercalcemia or conditions predisposing to hypercalcemia, such as patients with severe renal impairment and granulomatous diseases associated with increased calcitriol synthesis such as sarcoidosis, calcium renal calculi or history of such calculi.
Lactate is a substrate for gluconeogenesis. This should be taken into account when Lactated Ringer’s Injection is used in patients with type 2 diabetes.
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