A Comparison of Normal Saline and Lactated Ringer's IV Solution in the Treatment of

Shock
by Elizabeth A. Criss
email: crissrn@msn.com

Degree: Master of Science in Nursing

Institution: The University of Arizona -College of Nursing
Committee Chair: Shu-Fen Wung, PhD, RN; Adam DaDeppo, ACNP
Year: 2007
Type of Document: MastersProject
Keywords: shock; normal saline; lactated Ringer's; hydration

Abstract: In most cases of shock reducing morbidity and mortality depends on

adequate, appropriate, and timely fluid resuscitation. To develop an effective
resuscitation plan the Acute Care Nurse Practitioner (ACNP) must consider several
important factors. Currently a wide variety of literature exists on the treatment of
patients in need of fluid resuscitation due to shock; however there is limited
agreement on a fluid or combination of fluids that provide the most benefit. The
purpose of this project is to review the resuscitation literature related to the use of
normal saline and lactated Ringers for shock resuscitation. The review examines
the literature concerning the effect of these fluids on metabolic pH, coagulation
factors, the inflammatory cascade, and cellular apoptosis. Data show that large
volumes of normal saline does cause a metabolic acidosis and dilutes circulating
clotting factors, however this appears to be transitory. Lactated Ringers does not
cause a metabolic acidosis, but more fluid is required for resuscitation from massive
hemorrhage and it increases the rate of cellular apoptosis. Both fluids cause an
increase in adhesion properties (CD18), an indication of inflammatory response.
Currently there is no ideal resuscitation fluid and consideration should be given to
including both fluids for large volume resuscitation. A combination mitigates the
potential consequences that occur with one fluid alone. It is important for the ACNP
utilize the current literature to design a resuscitation strategy that meets the needs
of the patient but minimizes the long term complications.

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