Ringer's lactate solution

Ringer's lactate solution is commonly used for fluid resuscitation after blood loss due to trauma or surgery. It is extensively used in aggressive volume resuscitation, e.g. for patients with pancreatitis, hemorrhagic shock or major burn injuries. In acidotic states, such as in acute kidney failure, Ringer's lactate solution may be advantageous as the byproducts of lactate metabolism in the liver counteract the acidosis. In a large-volume resuscitation over several hours, Ringer's lactate solution maintains a more stable blood pH than normal saline. Ringer's lactate and other crystalloid fluids are also used as vehicles for the intravenous (IV) delivery of medications. == Chemistry ==

One liter of Ringer's lactate solution contains: • 130–131 mEq of sodium ion = 130 mmol L−1 • 109–111 mEq of chloride ion = 109 mmol L−1 • 28–29 mEq of lactate ion = 28 mmol L−1 • 4–5 mEq of potassium ion = 4 mmol L−1 • 2–3 mEq of calcium ion = 1.5 mmol L−1 Ringer's lactate has an osmolarity of 273 mOsm L−1 There are slight variations for the composition for Ringer's as supplied by different manufacturers. As such, the term Ringer's lactate should not be equated with one precise formulation. == History ==

Ringer's saline solution was invented in the early 1880s by Sydney Ringer, a British physician and physiologist. Ringer was studying the beating of an isolated frog heart outside of the body. He hoped to identify the substances in blood that would allow the isolated heart to beat normally for a time. The use of Ringer's original solution of inorganic salts slowly became more popular. In the 1930s, the original solution was further modified by American pediatrician Alexis Hartmann for the purpose of treating acidosis. Hartmann added lactate, which mitigates changes in pH by acting as a buffer for acid. Thus the solution became known as "Ringer's lactate solution" or "Hartmann's solution". ==Formulations==

Ringer's solution technically refers only to the saline component, without lactate. Some countries instead use a Ringer's acetate solution or Ringer-acetate, which has similar properties. This was thought to be helpful when analyzing blood-lactate for signs of anaerobic metabolism (e.g. present with septic shock, hypovolemic shock). Subsequently, it has been shown that lactate is metabolized much faster than infused. Ringers lactate should not cause an elevated blood-lactate level except possibly in the most severe presentations of liver failure. == Veterinary use ==

It is used for the treatment or palliative care of chronic kidney failure in small animals. The solution can be administered intravenously or subcutaneously. Administering the fluids subcutaneously allows the solution to be readily given to the animal by a trained layperson, as it is not required that a vein be located. The solution is slowly absorbed from beneath the skin into the bloodstream of the animal. == See also ==