GENERIC NAME: Sodium lactate solution & Hartmann’s solution

BRAND NAME: Lactated Ringer

CLASSIFICATION: Intravenous nutritional products
MODE OF ACTION: Lactated Ringer’s Injection, USP 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, USP produces a metabolic
alkalinizing effect. Lactate ions are metabolized ultimately to
carbon dioxide and water, which requires the consumption of
hydrogen cations.

DOSE AND ROUTE:

Adults and adolescence
Maximum daily dose
Up to 40mLper kg body weight (BW)/day, corresponding to 5.24
mmol sodiumper kg BW per day and max. .22 mmol potassiumper
kg BW/day.
Maximum infusion rate
The infusion rate should be adjusted according to the patient’s
clinical condition.
The infusion rate should normally not exceed the following values:
5m/kg BW/hr
INDICATION: Lactated Ringer’s Injection, USP is indicated as a source of water
and electrolytes or as an alkalinizing agent.
CONTRAINDICATION:
• Newborns (≤28 days of age) receiving concomitant treatment with
ceftriaxone, even if separate infusion lines are used due to the risk of fatal
ceftriaxone-calcium salt precipitation in the neonate’s bloodstream.
• Patients older than 28 days, including adults, administered ceftriaxone
simultaneously through the same infusion line (e.g., via a Y-connector). If the
same infusion line is used for sequential administration, the line must be
thoroughly flushed between infusions with a compatible fluid.
 • Patients with known hypersensitivity to sodium lactate

SIDE EFFECTS: Abdominal or stomach pain, bloating or swelling of the face,

arms, hands, lower legs, or feet, blurred vision, body aches or pain, chills,
confusion, convulsions, cough, decreased urine, difficulty with breathing

ADVERSE EFFECTS: dizziness, dizziness, faintness, or lightheadedness when

getting up suddenly from a lying or sitting position, dry mouth, ear congestion,
fever, headache, increased thirst, irregular heartbeat, loss of appetite, loss of
voice and muscle pain or cramps

DRUG INTERACTIONS:
Ceftriaxone

Caution is advised when administering Lactated Ringer's Injection to patients

treated with drugs that may increase the risk of sodium and fluid retention, such
as corticosteroids.

Caution is advised when administering Lactated Ringer's Injection to patients

treated with drugs for which renal elimination is pH dependent. Due to the
alkalinizing action of lactate (formation of bicarbonate), Lactated Ringer's
Injection may interfere with the elimination of such drugs.

 Renal clearance of acidic drugs such as salicylates and barbiturates may

be increased.
 Renal clearance of alkaline drugs, such as sympathomimetics (e.g.,
ephedrine, pseudoephedrine) and dextroamphetamine (dexamphetamine)
sulfate, may be decreased.

Renal clearance of lithium may also be increased. Caution is advised when

administering Lactated Ringer's Injection to patients treated with lithium.

Because of its potassium content, Lactated Ringer's Injection should be

administered with caution in patients treated with agents or products that can
cause hyperkalemia or increase risk of hyperkalemia, such as potassium sparing
diuretics (amiloride, spironolactone, triamterene), with ACE inhibitors,
angiotensin II receptor antagonists, or the immunosuppressants tacrolimus and
cyclosporine.

Caution is advised when administering Lactated Ringer's Injection to patients

treated with thiazide diuretics or vitamin D, as these can increase the risk of
hypercalcemia.
NURSING RESPONSIBILITIES:
 Document baseline vital signs, edema, lung sounds, and heart sounds,
and continue monitoring during and after the infusion.
 Monitor for continued signs of hypovolemia, including urine output < 0.5
mL/kg/hour, poor skin turgor, tachycardia, weak pulse, and hypotension.
 Monitor for signs of hypervolemia such as hypertension, bounding pulse,
pulmonary crackles, dyspnea, shortness of breath, peripheral edema,
jugular vein distension (JVD) and extra heart sounds such as S3
 Administer only in high acuity areas.
 For short-term use to correct critical electrolyte abnormalities.
 Monitor electrolytes and assess for hypervolemia. ...
 Avoid in patients with cardiac or renal conditions who are dehydrated, and
in patients with diabetic ketoacidosis.

DRUG INTERACTION NI SYA SA SALBUTAMOL

Tell your doctor of all prescription and nonprescription medications you use,
including: beta-blockers (e.g., propranolol, timolol), all asthma
medications, ephedrine, epinephrine, pseudoephedrine, antidepressants, MAO
inhibitors (e.g., furazolidone, linezolid, phenelzine, selegiline, tranylcypromine),
diuretics (e.g., hydrochlorothiazide). It is important to read the labels carefully on
all over-the-counter medications, especially those used for colds, allergies,
asthma or diets as they may contain ingredients mentioned above. Do not start
or stop any medicine without doctor or pharmacist approval.