Lactated Ringers
(Sodium Chloride, Sodium Lactate, Potassium Chloride, Calcium Chloride)Lactated Ringers Prescribing Information
Lactated Ringer's Injection is indicated as a source of water and electrolytes or as an alkalinizing agent.
As directed by a physician. Dosage, rate and duration of administration are to be individualized and dependent upon the indication for use, the patient's age, weight, concomitant treatment and clinical condition of the patient as well as laboratory determinations.
All injections in flexible plastic containers are intended for intravenous administration using sterile and nonpyrogenic equipment.
After opening the container, the contents should be used immediately and should not be stored for a subsequent infusion. Do not reconnect any partially used containers.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Do not administer unless the solution is clear and seal is intact.
When making additions to Lactated Ringer's Injection, aseptic technique must be used. Mix the solution thoroughly when additives have been introduced. Do not store solutions containing additives.
Additives may be incompatible with Lactated Ringer's Injection. As with all parenteral solutions, compatibility of the additives with the solution must be assessed before addition, by checking for a possible color change and/or the appearance of precipitates, insoluble complexes, or crystals. Before adding a substance or medication, verify that it is soluble and/or stable in water and that the pH range of Lactated Ringer's Injection is appropriate.
The instructions for use of the medication to be added and other relevant literature must be consulted. Additives known or determined to be incompatible should not be used.
As for other calcium-containing infusion solutions, concomitant administration of ceftriaxone and Lactated Ringer's Injection is contraindicated in newborns (≤ 28 days of age), even if separate infusion lines are used (risk of fatal ceftriaxone-calcium salt precipitation in the neonate's bloodstream).
In patients older than 28 days (including adults), ceftriaxone must not be administered simultaneously with intravenous calcium-containing solutions, including Lactated Ringer's Injection, through the same infusion line (e.g., via Y-connector). If the same infusion line is used for sequential administration, the line must be thoroughly flushed between infusions with a compatible fluid.
Lactated Ringer's Injection is contraindicated in patients with a known hypersensitivity to sodium lactate.
The following adverse reactions have been reported in the post-marketing experience, listed by MedDRA System Organ Class (SOC).
Ceftriaxone (see
As for other calcium-containing infusion solutions, concomitant administration of ceftriaxone and Lactated Ringer's Injection is contraindicated in newborns (≤ 28 days of age), even if separate infusion lines are used (risk of fatal ceftriaxone-calcium salt precipitation in the neonate's bloodstream).
In patients older than 28 days (including adults), ceftriaxone must not be administered simultaneously with intravenous calcium-containing solutions, including Lactated Ringer's Injection, through the same infusion line (e.g., via Y-connector). If the same infusion line is used for sequential administration, the line must be thoroughly flushed between infusions with a compatible fluid.
Lactated Ringer's Injection is contraindicated in patients with a known hypersensitivity to sodium lactate.
Caution is advised when administering Lactated Ringer's Injection to patients treated with drugs that may increase the risk of sodium and fluid retention, such as corticosteroids.
Caution is advised when administering Lactated Ringer's Injection to patients treated with drugs for which renal elimination is pH dependent. Due to the alkalinizing action of lactate (formation of bicarbonate), Lactated Ringer's Injection may interfere with the elimination of such drugs.
- Renal clearance of acidic drugs such as salicylates and barbiturates may be increased.
- Renal clearance of alkaline drugs, such as sympathomimetics (e.g., ephedrine, pseudoephedrine) and dextroamphetamine (dexamphetamine) sulfate, may be decreased.
Renal clearance of lithium may also be increased. Caution is advised when administering Lactated Ringer's Injection to patients treated with lithium.
Because of its potassium content, Lactated Ringer's Injection should be administered with caution in patients treated with agents or products that can cause hyperkalemia or increase risk of hyperkalemia, such as potassium sparing diuretics (amiloride, spironolactone, triamterene), with ACE inhibitors, angiotensin II receptor antagonists, or the immunosuppressants tacrolimus and cyclosporine.
Caution is advised when administering Lactated Ringer's Injection to patients treated with thiazide diuretics or vitamin D, as these can increase the risk of hypercalcemia.
Lactated Ringer's Injection, USP is a sterile, nonpyrogenic solution for fluid and electrolyte replenishment in single dose containers for intravenous administration. It contains no antimicrobial agents. Composition, osmolarity, pH, ionic concentration and caloric content are shown in
Size (mL) | Composition (g/L) | Ionic Composition (mEq/L) | Caloric Content (kcal/L) | ||||||||||
| Sodium Chloride, USP (NaCl) | Sodium Lactate, USP (C3H5NaO3) | Potassium Chloride, USP (KCl) | Calcium Chloride, USP (CaCl2•2H2O) | Osmolarity (mOsmol/L) (calc) | pH | Sodium | Potassium | Calcium | Chloride | Lactate | |||
| Lactated Ringer's Injection, USP | 250 | 6 | 3.1 | 0.3 | 0.2 | 273 | 6.5 (6.0 to 7.5) | 130 | 4 | 2.7 | 109 | 28 | 9 |
| 500 | |||||||||||||
| 1,000 | |||||||||||||
Size (mL) | Composition (g/L) | Ionic Composition (mEq/L) | Caloric Content (kcal/L) | ||||||||||
| Sodium Chloride, USP (NaCl) | Sodium Lactate, USP (C3H5NaO3) | Potassium Chloride, USP (KCl) | Calcium Chloride, USP (CaCl2•2H2O) | Osmolarity (mOsmol/L) (calc) | pH | Sodium | Potassium | Calcium | Chloride | Lactate | |||
| Lactated Ringer's Injection, USP | 250 | 6 | 3.1 | 0.3 | 0.2 | 273 | 6.5 (6.0 to 7.5) | 130 | 4 | 2.7 | 109 | 28 | 9 |
| 500 | |||||||||||||
| 1,000 | |||||||||||||
The flexible container is fabricated from a specially formulated non-plasticized, film containing polypropylene and thermoplastic elastomers (