Ringer's solution

Instruction manual

For medical use of the drug

Ringers solution

(solutio ringeri)

Structure:

Active substances: sodium chloride, potassium chloride, calcium chloride dihydrate;

100 ml of the solution contain sodium chloride - 0.86 g; potassium chloride - 0.03 g; calcium chloride dihydrate - 0.0322 g;

excipient: water for injection.

Ionic composition per 1000 ml of the drug: Na⁺ - 147.15 mmol; K⁺ - 4.016 mmol; Ca⁺⁺ - 2.19 mmol; Cl^— - 155.60 mmol.

Dosage form.

Solution for infusion.

Basic physical and chemical properties: transparent, colorless liquid; theoretical osmolarity - 309 mosmol / l; pH 5.0–7.5.

Pharmacotherapeutic group.

Solutions for intravenous administration. solutions used to correct electrolyte imbalance. code atx v05v v01.

Pharmacological properties.

Pharmacodynamics

Ringers solution is a source of water and electrolytes. It can induce diuresis depending on the condition of the patient.

Sodium, the main cation of extracellular fluid, is involved primarily in controlling the distribution of water, water balance, and the osmotic pressure of body fluids. Sodium is also associated with chlorine and bicarbonate in regulating the acid-base balance of body fluids.

Potassium, the main cation of intracellular fluid, takes part in the utilization of carbohydrates and the synthesis of proteins; it is necessary for the regulation of neural conduction and muscle contraction, especially the heart.

Chlorine, the main extracellular anion that is closely associated with sodium metabolism, and changes in the acid-base balance of the body are accompanied by changes in the concentration of chlorine. Infusion of a large number of chlorine ions can cause loss of bicarbonate ions, leading to acidosis. For this reason, Ringers solution is buffered with lactate or acetate.

Calcium, an important cation that provides the formation of bones and teeth (in the form of calcium phosphate and calcium carbonate). In the ionized form, calcium is needed for the functional mechanism of blood coagulation, normal heart function, and regulation of neuromuscular excitability.

Pharmacokinetics

Ions Na⁺ and Cl^—introduced with Ringers solution have the same pharmacokinetics as those received with food. They are freely distributed in all organs, tissues and intercellular spaces and are secreted by glomerular filtration in the kidneys. In the tubules, there is a significant reabsorption of Na ions⁺ and Cl^—, mainly in the loop of Henle and the distal tubules, including the blocking mechanism of loop and thiazide diuretics, respectively.

Potassium ions (K⁺) are freely filtered in the glomeruli, but almost completely reabsorbed in the proximal tubules and excreted only 10% of the filtered K ions⁺. Secretion in distal tubules and collecting ducts can significantly increase K elimination⁺. The kidneys have a limited ability to maintain a concentration of K⁺. Therefore, when the concentration of Na⁺ in distal tubules high, loss K⁺ may be significant and hypokalemia may develop. This determines the presence of K⁺ in ringers solution.

Homeostasis of calcium ions (Ca⁺⁺) is well controlled by hormones and rarely needs clinical intervention with intravenous infusion of a solution.

Clinical characteristics.

Indications.

It is used for hypovolemia and extracellular dehydration due to prolonged vomiting, diarrhea, extensive burns, frostbite, peritonitis, severe infectious diseases, shock conditions, collapse; during surgery and in the postoperative period.

Used to dilute concentrated electrolyte solutions.

Contraindications

• Hypernatremia; hyperkalemia hypercalcemia; overhydration; metabolic alkalosis; decompensated heart failure; oliguria and anuria; acute renal failure; pulmonary edema; cerebral edema; hypercoagulation; thrombophlebitis.

Interaction with other drugs and other types of interactions.

A possible increase in sodium retention in the body with the simultaneous use of such drugs: non-steroidal anti-inflammatory drugs, androgens, anabolic hormones, estrogens, corticotropin, mineralocorticoids, vasodilators or ganglion blockers.

When used with potassium-sparing diuretics, ACE inhibitors and potassium preparations, the risk of developing hyperkalemia is increased.

In combination with cardiac glycosides, the likelihood of their toxic effects increases.

Features of the application.

During long-term parenteral therapy, it is necessary to determine laboratory parameters and give a clinical assessment of the patients condition to monitor the concentration of electrolytes and water-electrolyte balance every 6 hours (depending on the rate of infusion).

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

Due to the content of sodium ions, the solution should be used with caution in patients with renal and cardiovascular insufficiency, with congestive heart failure, especially in the postoperative period or in elderly patients, as well as in patients with clinical conditions accompanied by sodium retention and edema.

Solutions containing sodium should be used with caution in patients receiving corticosteroids or corticotropin.

Potassium content requires caution when applying the solution to patients with heart disease, hyperkalemia, severe renal failure and clinical conditions, accompanied by a delay in potassium in the body.

Potassium should be administered under ECG monitoring, especially for patients receiving digitalis. Serum calcium levels do not always reflect tissue levels of calcium.

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

The presence of calcium ions requires caution in case of simultaneous administration with blood products through the likelihood of developing coagulation.

Parenteral administration of calcium is necessary with particular attention to patients receiving cardiac glycosides.

This solution is intended for intravenous use using sterile equipment. It is recommended to change the intravenous system at least every 24 hours.

Use the solution only when it is transparent and the bottle is sealed.

The doctor should also consider the possibility of developing adverse reactions to drugs that are used simultaneously with Ringers solution.

If an adverse reaction occurs, discontinue the infusion, assess the patients condition and prescribe the necessary therapeutic measures.

Use during pregnancy or lactation.

Studies on the use of the ring of the solution to pregnant women have not been conducted.

It is not known whether this drug passes into human milk. Since most drugs penetrate human milk, it is necessary to carefully prescribe Ringers solution to women during breast-feeding.

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.

The solution is intended for intravenous use only.

The dose is prescribed by a doctor and depends on the age, body weight, clinical condition of the patient and laboratory parameters.

The usual dose for an adult is up to 1-2 liters per day; the maximum dose depends on the state of the water-electrolyte balance, cardiovascular system and kidneys.

The infusion rate for adults is 60–80 drops / minute or in a jet.

The purpose of the solution should be based on the calculated maintenance or replacement fluid requirements for each patient.

Before use, parenteral preparations should be visually checked for particles and discoloration.

Children.

Studies on the use of a ring of solution for children have not been conducted.

Overdose.

The introduction of too much solution can lead to imbalance in the fluid, electrolytes (hypervolemia, hypernatremia, hypercalcemia, hyperchloremia) and acid-base balance. symptomatic therapy.

Adverse Reactions

Disruptions in the exchange of electrolytes (potassium, calcium, sodium, chlorine), chloride acidosis, and hyperhydration can be observed.

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

Shelf life.

3 years.

Storage conditions.

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

Incompatibility.

To reduce the risk of possible incompatibility when mixing this solution with other prescribed additives, the final infusion solution should be checked for turbidity or precipitation immediately after mixing, before use and periodically during use.

Packaging.

200 ml and 400 ml in bottles.

Vacation category.

On prescription.

Manufacturer.

Private joint-stock company "infusion".

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

Ukraine, 21034 Vinnitsa, st. Voloshkova, 55

or

Ukraine, 23219, Vinnytsia region., Vinnytsia district, s. Vinnytsia Khutor, st. Nemirovskoe highway, 84A.

Applicant

Private joint-stock company "infusion".

Location of the applicant and / or representative of the applicant.

Ukraine, 04073, Kiev, Moscow Avenue, d. 21-a.