Ringer's Lactate Solution

Instruction manual

For medical use of the drug

Ringers Lactate Solution

(ringer’s lactate solution)

Structure:

Active ingredients: sodium chloride, potassium chloride, sodium lactate, calcium chloride dihydrate;

100 ml of the solution contains: sodium chloride - 0.602 g; potassium chloride - 0.0373 g; sodium lactate - 0.3138 g; calcium chloride dihydrate - 0.0294 g;

ionic composition per 1000 ml of solution: Na⁺ - 131 mmol, K⁺ - 5 mmol, Ca⁺⁺ - 2 mmol,

Cl⁻ - 112 mmol, lactate - 28 mmol;

excipients: water for injection.

Dosage form.

Solution for infusion.

Basic physical and chemical properties: transparent, colorless liquid; theoretical osmolarity - 278 mosmol / l; pH 5.5–7.5.

Pharmacotherapeutic group.

Plasma replacement and perfusion solutions. solutions for the correction of electrolyte imbalance. electrolytes.

Code ATX B05V B01.

Pharmacological properties.

Ringers Lactate Solution is a saline solution with a balanced electrolyte content. compensates for the deficit in the volume of circulating blood. lactate, which is part of the drug, as a result of metabolic processes turns into bicarbonate anions, which slightly changes the reaction of the blood to the alkaline side. the solution also has a detoxifying effect due to a decrease in the concentration of toxic products in the blood and activation of diuresis. the solution is close to isotonic.

Pharmacokinetics With intravenous administration of the drug, blood osmolality increases for a short time. After about half an hour, the drug penetrates the tissues. The components of the drug are excreted in the urine.

Clinical characteristics.

Indications.

Correction of water-electrolyte balance disorders during isotonic and hypotonic dehydration due to fluid loss during vomiting, diarrhea, inadequate fluid intake, bile and intestinal fistulas, as well as to restore water-electrolyte balance in preparing patients for surgery and in the postoperative period. metabolic acidosis.

Contraindications

Hypervolemia, hypernatremia (including due to the use of corticosteroids), hyperkalemia, hyperchloremia, hypertonic dehydration, alkalosis, lactic acidosis, severe arterial hypertension, severe dysfunction of the heart and / or kidneys, liver failure (due to a decrease in the formation of bicarbonate from lactate) lungs, thrombophlebitis, conditions with increased blood coagulation, decompensated heart defects.

Oliguria, anuria; acute renal failure; cerebral edema; hypercalcemia; extracellular hyperhydration.

Interaction with other drugs and other types of interactions.

When using potassium-sparing diuretics, angiotensin-converting enzyme inhibitors (APF) and potassium preparations, the risk of developing hyperkalemia is increased. with the simultaneous use of the drug “ringa lactate solution” and cardiac glycosides, the toxic effect of the latter is enhanced due to the presence of Ca ++ ions in the solution.

The drug is incompatible with cefamandol, amphotericin, ethyl alcohol, thiopental, aminocaproic acid, metaraminol, ampicillin, vibramycin and monocycline.

It is not recommended to use "Ringers Lactate Solution" as a means for diluting antibiotics administered by infusion, as well as for diluting anti-inflammatory drugs.

It is possible to increase sodium retention in the body while using such drugs: non-steroidal anti-inflammatory drugs (NSAIDs), androgens, anabolic hormones, estrogens, corticotropins, mineralocorticoids, vasodilators or ganglion blockers.

Due to the presence of lactate in the composition of the drug, which alkalizes the pH, Ringers Lactate Solution should be used with caution simultaneously with drugs whose renal elimination depends on pH. Renal clearance of salicylates, barbiturates, lithium may decrease, and sympathomimetics and stimulants (such as dexamphetamine sulfate, fenfluramine hydrochloride) may increase.

Features of the application.

During the infusion therapy with Ringers Lactate Solution, it is necessary to evaluate the patient’s clinical condition based on monitoring the concentration of electrolytes, water-electrolyte balance, pH and pcO2, and the level of lactate (during massive infusions).

Due to the content of sodium ions, Ringers Lactate Solution should be used with caution in patients with arterial hypertension, renal and cardiovascular insufficiency, elderly patients, as well as patients with clinical conditions accompanied by sodium retention and edema, patients with hypoxia and liver failure .

The use of intravenous solutions can cause fluid overload, hyperhydration, congestion and pulmonary edema. The risk of dilution develops inversely with the concentration of electrolytes. The risk of a solution overload that causes congestion with peripheral edema and pulmonary edema is directly proportional to the concentration of electrolytes.

In case of any manifestations of a hypersensitivity reaction, you should immediately stop the introduction of the solution and carry out appropriate treatment.

Since the drug contains sodium lactate, it should be used with caution in patients prone to hypernatremia (for example, with adrenocortical insufficiency, diabetes insipidus or massive tissue damage), and in patients with heart disease; due to the content of sodium ions, the solution should be used with caution in patients with renal and cardiovascular failure, with congestive heart failure, especially in the postoperative period, as well as in patients with clinical conditions that are accompanied by sodium retention and edema.

Solutions that contain sodium should be prescribed with caution to patients who use corticosteroids or corticotropin.

Due to the potassium content, caution is required when applying the solution to patients with heart diseases and clinical conditions that are accompanied by a delay in potassium in the body.

In the case of calcium, it is necessary to control cardiac activity using electrocardiography (ECG), especially in patients who use digitalis. Serum calcium levels do not always reflect tissue calcium levels.

In patients with reduced excretory function of the kidneys, the use of a solution can lead to a delay in sodium or potassium in the body.

Due to the presence of calcium ions in the solution, caution is required with the simultaneous use of blood products, since coagulation may develop.

In the case of the administration of calcium parenterally to patients who receive cardiac glycosides, special attention is required.

Lactate is a substrate for gluconeogenesis, therefore, it is necessary to carefully monitor the level of glucose in the blood of patients with type II diabetes mellitus.

Use during pregnancy or lactation.

The drug should be used for health reasons when the expected benefit to the mother outweighs the possible risk to the fetus / child.

The ability to influence the reaction rate when driving vehicles or other mechanisms.

Data are not available due to the use of the drug exclusively in a hospital setting.

Dosage and administration.

Introduce intravenously. the dose is prescribed by the doctor depending on the condition of the patient.the maximum daily dose for adults is 40 ml / kg / day (an average of 2500 ml at a rate of 60 drops / min). the duration of treatment depends on the condition of the patient.

Children.

In pediatrics is not used due to the lack of clinical trials.

Overdose.

An overdose or too rapid administration of the solution can lead to a violation of the water-electrolyte balance, alkalosis, cardiopulmonary decompensation. in this case, the administration of the drug should be stopped immediately. conduct symptomatic therapy.

Excessive administration of lactate can lead to the development of metabolic alkalosis, which, in turn, may be accompanied by hypokalemia. Symptoms: mood swings, fatigue, shortness of breath, muscle weakness, polydipsia, polyuria, impaired thinking, arrhythmia. Muscle hypertonicity, twitching, and tetanic cramps can occur in patients with hypocalcemia.

Adverse Reactions

Electrolyte imbalance: a change in the level of electrolytes (potassium, calcium, sodium, chlorine) in the blood serum; metabolic alkalosis; chloride acidosis.

General reactions of the body: hypervolemia; allergic or anaphylactic reactions (fever, itching, coughing, sneezing, shortness of breath, local or generalized urticaria, angioedema).

Changes in the place of infusion: inflammation, swelling, redness, rash, itching, burning, pain, numbness at the site of infusion, thrombophlebitis.

Mental disorders: panic attack.

Rapid administration of the drug can cause acute circulatory failure and pulmonary edema.

In case of adverse reactions, the administration of the solution should be discontinued, the patients condition assessed and appropriate assistance provided.

Shelf life.

5 years.

Storage conditions.

Store at a temperature not exceeding 25 ° C. Keep out of the reach of children.

Incompatibility.

The drug should not be mixed with phosphate and carbonate solutions.

Packaging.

200 ml or 250 ml, or 400 ml, or 500 ml in bottles.

Vacation category.

On prescription.

Manufacturer.

Private joint-stock company "infusion".

The location of the manufacturer and the address of the place of business.

Ukraine, 23219, Vinnitsa region, Vinnitsa district, s. Vinnytsia farms, st. Nemirovskoe highway, 84a