What is Lactic Acid Ringer?
[Concept Explanation]
1. Basic Attributes Lactic Acid Ringer. The actual standardized name often refers to Sodium Lactate Ringer Injection, which is essentially a compound preparation and belongs to the crystalline intravenous infusion liquid. The solution mainly contains sodium ions, potassium ions, calcium ions, chloride ions, and lactate ions. These ion ratios simulate the normal levels of human plasma electrolytes and are widely used to supplement body fluids and balance blood concentrations. This type of medicine itself does not have active ingredients that directly treat diseases, but can provide a basic therapeutic environment for disease assistance.
2. Ingredient characteristics: Each 100ml of sodium lactate Ringer injection corresponds to 6.00g of sodium chloride, 0.30g of potassium chloride, 0.20g of calcium chloride, and 3.10g of sodium lactate. The total sodium content is 130mmol/L, and the osmotic pressure range is between 273 and 298mOsm/L, almost equal to plasma. After input, it can quickly balance the pressure gradient inside and outside the cell. 【 Scope of adaptation and prohibited conditions 】
3. Main indications: The direction of adaptation is strictly limited to supplement and regulate when there is fluid imbalance. The actual applicable symptoms include insufficient circulation capacity caused by acute vomiting or diarrhea (such as heat and dehydration, early coma in acute gastroenteritis), fluid resuscitation in the early stage of moderate to severe burns, and bradycardia caused by electrolyte imbalance to assist in environmental correction (such as potassium deficiency). In addition, after surgical trauma, the injection can also be used for basic volume expansion and to maintain the stability of blood circulation during the surgical period.
Prohibited cases include sudden shock induced fluid deficiency in patients with moderate to severe renal insufficiency or chronic congestive heart failure, as their renal excretion function and circulatory compensatory ability are inhibited. Excessive supplementation of sodium and potassium ions may exacerbate acute pulmonary edema, leading to rapid breathing and arrhythmia. In severe cases, perfusion therapy may be terminated.
Examples of clinical compatibility contraindications need to be recorded:
4. Physical and chemical conflict destruction. Typical non mixable antibiotics such as ceftriaxone will form white suspension crystals with sodium lactate Ringer due to the reaction between divalent calcium and the anionic carboxylic acid group of cephalosporin drugs, forming a metal macromolecule precipitation structure. If combined medication is necessary, calcium free crystal solution can be used as a substitute for this product.
The instructions for certain targeted cancer drugs strictly prohibit the use of carrier solvents other than sodium chloride or sodium chloride for dilution. For example, etoposide liposomes and complex ester formulations of paclitaxel cannot be used in combination with this product, otherwise it will cause the collapse of the packaging structure, complete inactivation of the drug by inorganic salts, and sudden acute failure during infusion.

Doctors need to choose the appropriate medication according to the manual guidelines.
【 Key Points for Operational Control 】
5. Implementation Framework of Medication Standards: In the medical environment, the emphasis is on the three essential control processes. The first step is to evaluate the patient's cardiac and pulmonary indicators data: whether the electrocardiogram indicates thickening of the QRS complex waveform (there is conduction block if it exceeds 110 milliseconds), whether the blood pressure is below the threshold of two-thirds of normal arterial pressure, and whether the pH of the blood test fluid gas analysis is below 7.30. When these hazardous parameters reach two to three criteria, liquid input should be suspended and transferred to the ICU level monitoring room for targeted treatment to prevent cell toxicity shock reactions.
The intravenous infusion speed parameter is recommended to not exceed 10ml/kg body weight for the first hour. The adult standard setting should refer to weight and capacity loss (estimate dehydration according to Rule 6.2); In the case of diabetes ketoacidosis in diabetes patients, due to excessive H+ions induced by combined ketone body accumulation, although fluid replacement is necessary, sodium concentration should be reduced, and 0.45% semiosmotic balanced saline and insulin should be preferentially used together to prevent rebound acidosis.
Unexpected signs during patient infusion, such as limb vein spasm leading to obstruction and sudden onset of lumbar soreness in the trunk, may indicate overload symptoms caused by excessive calcium ion supplementation. At this point, shallow meridian puncture can be performed from the middle and upper segment of the clavicle to guide medication. When there is no improvement, immediately cut off the fluid pathway and make a follow-up visit to determine if there is excessive mineral deposition damage.
【 Comparison of Similar Drugs and Typical Prescriptions 】
6. Differences in Same type Crystals Comparison. Ordinary physiological saline (0.9% NaCl) only supplements sodium and chlorine, does not contain potassium or calcium, and may have osmotic load and circulatory interference; Sodium bicarbonate complex salts are often used to correct specific types of metabolic acidosis, and their excessive sodium load cannot be replaced as an option for electrolyte expansion. Only the multiple ratios of lactate Ringer are closer to the real physiological salt ion spectrum in the body, and have superior application rates in routine surgical perioperative or fluid replacement management without special crises. The specific template prescription items issued by the doctor can be found in the following example operation sheet:
The dosage standard prescription is:
Sodium Lactate Ringer Injection 500ml
IV.drip QD. If the patient has muscle weakness type periodic paralysis, the speed should be adjusted according to the low potassium threshold to 50-70mL/min and the T-wave variability data should be dynamically monitored.
When a patient with large blood loss needs to expand the volume with hydroxyethyl starch during surgery, the total crystal/colloid ratio should be limited to 3:1, that is, not more than 750ml of Sodium Lactate Ringer Injection with 250ml of colloid solution per hour. Otherwise, the side effect of excessive blood volume expansion will increase the risk of ARDS after surgery.
【 Guidelines for Drug Storage Compliance 】

According to the regulations of the warehouse management, the inventory should be sealed and stored in a constant humidity environment of 30 50% RH according to the batch number. The storage location should be cool and the temperature range should be stable at 25 ° C, away from direct light sources.
. Individual cases of color turning yellow, such as the liquid color of Pu erh tea, or discovering the floating form of flocculent substances, should be immediately marked and scrapped. Due to the precipitation of trace glass fragments in the solution, it is necessary to separate and settle them at regular intervals, filter them out, and retest. The effective period shall not exceed 18 months, and the transportation and circulation period shall not be subjected to long-term freezing scenarios at -5 ℃ (to prevent crystal crystallization and particle structure damage).
The attribution of reference materials and the list of responsible parties can be found in Chapter 20, Section 3 of Part 4 of the Chinese Pharmacopoeia (202 edition) - Appendix C on Temperature Tolerance of Crystalline Drugs in the Quality Management Specification for Large Volume Injection Production.