Lactated Ringer's solution

Lactated Ringer's solution (LR; called Hartmann's solution outside North America) is a balanced isotonic crystalloid intravenous fluid containing sodium, potassium, calcium, chloride, and lactate (as sodium lactate) in concentrations approximating extracellular fluid. It is one of the most widely administered IV fluids in surgery, trauma, sepsis, and burns; the lactate component is metabolized hepatically to bicarbonate, providing a mild alkalinizing buffer. Compared with normal saline, LR causes less hyperchloremic metabolic acidosis at high volumes.

Crystalloid IV fluid, Electrolyte replacement

Lactated Ringer's solution

Lactated Ringer's Injection (Baxter, B. Braun, ICU Medical); Hartmann's solution (intl.)

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Summary

Classes

Crystalloid IV fluid, Electrolyte replacement

Common uses

Volume resuscitation▲0▼, Perioperative maintenance fluid▲0▼, Trauma and burn resuscitation▲0▼, Sepsis resuscitation▲0▼

Pharmacy

Starting dose

Volume titrated to clinical status; typical adult bolus 500-1000 mL, then reassess

Preparations

250, 500, 1000 mL IV bags. Composition per liter: Na+ 130 mEq, K+ 4 mEq, Ca2+ 3 mEq, Cl- 109 mEq, lactate 28 mEq

US FDA Max

No fixed maximum; titrated to clinical endpoints

Pharmacology

Routes

IV

Onset

Immediate intravascular expansion

Duration

Roughly 20-30% remains intravascular at 1 hour

Half-life

Not applicable (electrolyte solution)

Bioavailability

100% (IV)

Pregnancy

Standard resuscitation fluid in pregnancy

Legal status

Rx-only in US

Purported mechanism

Lactated Ringer's expands the extracellular volume isotonically; its electrolyte composition is closer to plasma than 0.9% saline, and the lactate is metabolized to bicarbonate by the liver, providing a mild alkalinizing buffer and avoiding the hyperchloremic metabolic acidosis that high-volume saline can produce.▲0▼ Calcium content is a relative contraindication for co-administration with citrated blood products through the same line.