![]() ![]() American Journal of Respiratory and Critical Care Medicine. Balanced crystalloids versus saline in critically ill adults with hyperkalemia or acute kidney injury: Secondary analysis of a clinical trial. D., & SMART Investigators and the Pragmatic Critical Care Research Group. Lactated ringers is to be given only by or under the supervision of your doctor. Pharmaceutical Lactated Ringers Ideal for sterile overhead irrigation Designed for easy non-drip pouring Lightweight, durable and shatterproof Not. It is also used as an alkalinizing agent, which increases the pH level of the body. ![]() Read other articles in the EM Pharm Pearls Series and find previous pearls on the PharmERToxguy site. Lactated Ringers injection is used to replace water and electrolyte loss in patients with low blood volume or low blood pressure. Want to learn more about EM Pharmacology? Given their more neutral pH, they may be preferred over normal saline in some patients. Braun R8306 Lactated Ringers Irrigation Solution, USP, 3000 mL, Pack of 4 Baxter Healthcare Solution Set with Duo-Vent Spike and 1 Injection Site, 103. Bottom Lineīalanced fluids (Lactated Ringer’s and Plasma-Lyte A) containing potassium can safely be used in patients with hyperkalemia. Additionally, he discusses the potential for normal saline to cause a non-anion gap metabolic acidosis thereby leading to increased serum potassium levels. Josh Farkas provides a succinct summary of this topic in a 2014 EMCrit/Pulmcrit post which is helpful in understanding the interplay between fluid balance and the different replacement options. Our results suggest that the acid-base effects of isotonic crystalloids are more important for potassium homeostasis than the relatively small amount of potassium in these fluids.Ī breakdown of the SMART Trial secondary analysis by Journal Feed summarizes other major findings and concludes, “It’s reasonable to choose LR to treat hyperkalemia over NS.” Lastly, Dr. EvidenceĪ secondary analysis of the SMART trial did not find a difference in severe hyperkalemia (K ≥7 mEq/L) in hyperkalemic patients that received a balanced fluid (8.5%) vs those that received normal saline (14%) (p=0.24). This is because the potassium concentration in these fluids is lower relative to the patient’s serum potassium level and dramatically lower than the patient’s intracellular potassium concentration. ![]() The answer is YES! Despite containing potassium, these fluids will still decrease the serum potassium level of a hyperkalemic patient. Table 1: Characteristics of IV fluids vs blood (* = mEq/L ^ = mOsmol/L) note: this is not an exhaustive list of fluid contentsĪ common question is if the balanced fluids containing potassium (Lactated Ringer’s and Plasma-Lyte A) are safe to use in hyperkalemia patients. There are three primary fluids used for resuscitation, each contains varying amounts of potassium per liter (Table 1):Īdditionally, these fluids contain markedly different amounts of other electrolytes, some of which directly influence their pH (Table 1). ![]()
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