IV fluids course (14): The million-dollar question, Lactated ringer (LR) or Normal saline (NS)???

#IVF #intravenousfluids #residency #internal medicine
Which solution to pick NS or LR?

[@DrNiteshRaj]

Great 🙏

[@Ζαμανφού]

I would like to ask a few questions please 1) is it true that RL is contraindicated in a Traumatic Brain Injury patient because it will worsen the brain edema? (Is this what also N/S 0,9 it will cause as it's Isotonic as well??) 2) Let's say we have a patient with severe blood loss for example from his leg. (Not head) What is the first fluid of choice to prevent the Hypovolemic shock and restore fluid, N/S 0,9 or RL? 3) Let's say we have a patient with severe Traumatic Brain injury, what is the best fluid to again, prevent Hypovolemic Shock and restore fluids, N/S 0,9 RL, or anything else? What IV fluid EMT is going to give for the above situations? Future EMT here, thanks!

[@Hospitalista]

Let me answer your questions in order, also I have to disclose that trauma isn’t my specialty : 1. In traumatic brain injury the concern is cerebral edema so it’s imperative to avoid any hypotonic solution, normal body osmolality is 270-290 million moles/Kg, 0.9 NS solution osmolarity is around 308 while LR around 270, you see that LR considered hypotonic compared to 0.9 NS, that’s why we prefer 0.9 NS as we need to avoid any hypotonicity in these patients 2. In this situation you should use whatever isotonic solution available whether this was 0.9NS, LR, or plasmalyte, in this case small difference in tonicity doesn’t matter 3. Again in traumatic brain injury 0.9 NS is the solution to use for the reasons I mentioned in the first point, as small differences in tonicity matters

[@Ζαμανφού]

@@Hospitalista thanks, really simple and informative answer!

[@Hospitalista]

@@Ζαμανφού You are most welcome!

[@theblackout27]

Very helpful, thanks!

[@johndamulira5932]

Can you transfuse blood and Ringers lactate simultaneously?

[@Hospitalista]

Yes why not, you may need to use a separate IV

[@tubeysr]

During trauma resuscitation, LR has proven to be an excellent initial intravenous fluid therapy due to its isoto- nicity and few side effects.8 Previous investigations have proven that the use of blood plus LR to treat hemorrhagic shock in animals and humans results in a more rapid return to cardiovascular stability, correction of acidosis, and de- creased mortality than does treatment with either blood alone or any other type of crystalloid solution.9,10 In clin- ical practice, LR has been administered during trauma resuscitation not only before, but also between blood trans- fusions without reported clinical complications.10 Blood bank recommendations state that normal saline solution should be used instead of LR while transfusing blood to increase the infusion rate and decrease the vis- cosity of PRBC.1-3 This recommendation is based on in- vestigations demonstrating that calcium-containing solu- tions can initiate in vitro coagulation in citrated blood.5,6 LR contains 0.020 g CaCl2 per liter of solution. A unit of WB contains approximately 63 mL CPD or 1.66 g citrate, and one unit of PRBC contains approximately 0.520 g citrate. Ryden and Oberman5 demonstrated that trace amounts of clot could be obtained from intravenous tubing at a whole blood to LR volume ratio of 1:1 at room temperature. Fibrin clots were seen when the flow rate was slow (60 drops per minute). In that study, gross clot for- mation was observed at a blood:LR volume concentration of 1:5 at a temperature of 37°C. They concluded that clot formation may be produced more frequently than expected when blood is transfused with LR in situations where the flow is slow and the ambient temperature is high.5 Other studies have demonstrated no significant difference in clot formation between PRBC diluted with LR com- pared with PRBC diluted in NS. One study demonstrated no difference in filter weights when comparing PRBC diluted in LR versus NS when they were transfused through a filter at 540 mL/hr.11 Cull et al12 showed that there was no significant clot formation with the dilution of PRBC and LR at clinically relevant levels (5:1, 3:1, and 2:1). Another study showed that no significant difference in microaggregate numbers or size was found when red blood cells were reconstituted with NS versus LR. (copied from studies)

[@naturallynursing5392]

Yes, but never on the same IV. They are not compatible through the same line. Safe through a separate IV line.

[@deathnotelover11]

Thank you for this very helpful video :)

[@Hospitalista]

Glad it was helpful!

[@rahmamohammed2103]

I'm not sick. I just need some fluid inside my body to hydrate it better. Which one should I go for?

[@sarrajable]

Water

[@daphneraven6745]

Perhaps Is worth your while to discuss your hydration needs with your local dietitian. So obviously, you need to drink some water, because that’s what our bodies use; if you’re having trouble hydrating, or you just feel bloated after you drink, water, and unsatisfied, like you’re still very thirsty, despite feeling bloated from the last drink, then talk with your dietician about appropriate minerals or electrolyte formulation. Most of the commercially available beverages that are marketed as though they are healthy and for the purpose of replenishing electrolytes, R is full of sugar as many soft drinks. you can do a little homework before seeing your dietitian: think about everything that you eat today, and listed. Snacks and all. Then do the same thing yesterday. And see if you can work up a whole week or two weeks worth of what you eat in the run of the day. Be honest. Even the mistakes that you make could be good indications about something going on with your body that might be important to address. i’m times certain medication‘s caused you to feel thirsty all the time, but it’s not possible to satisfy that thirst, and you can cause problems that way. That’s also possibly what’s getting used up in your body as your body deals with whatever you have. And also just a side effect of minutes. So once you have things worked through with your medical people, hopefully you’ll be in much better shape. At that point, you should be able to enjoy hydrating with water.

[@johnwills1113]

We cant read your writing. Use notation. such as ^K+ instead of hyperkalemia.

[@Hospitalista]

Am working on fixing all of that