Is Lactated Ringer’s Solution Safe for Hyperkalemia Patients?

Background There are three primary fluids used for resuscitation, each contains varying amounts of potassium per liter (Table 1): 0.9% Sodium Chloride (normal saline) Lactated Ringer’s solution Plasma-Lyte A Additionally, these fluids contain markedly different amounts of other electrolytes, some of which directly influence their pH (Table 1). Solution Na* Cl* K* Ca* Lactate* Acetate* Osmolarity^ pH Sodium Chloride 0.9% (normal saline) 154 154 – – – – 308 5.5 Lactated Ringer’s 130 109 4 2.7 28 – 273 6.5 Plasma-Lyte A 140 98 5 – 27 294 7.4 Blood 135-145 96-106 3.5-5 8.5-10.5 0-1 NA 275-295 7.35-7.45 Table 1: Characteristics of IV fluids vs blood [1-3] (* = mEq/L; ^ = mOsmol/L); note: this is not an exhaustive list of fluid contents A common question is if the balanced fluids containing potassium (Lactated Ringer’s and Plasma-Lyte A) are safe to use in hyperkalemia patients. The answer is YES! Despite containing potassium, these fluids will still decrease the serum potassium level of a hyperkalemic patient. This is because the potassium concentration in these fluids is lower relative to the patient’s serum potassium level and dramatically lower than the patient’s intracellular potassium concentration. Evidence A secondary analysis of the SMART trial did not find a difference in severe hyperkalemia (K ≥7 mEq/L) in hyperkalemic patients that received a balanced fluid (8.5%) vs those that received normal saline (14%) (p=0.24) [4]. The authors concluded that: Our results suggest that the acid-base effects of isotonic crystalloids are more important for potassium homeostasis than the relatively small amount of potassium in these fluids. A breakdown of the SMART Trial secondary analysis by Journal Feed summarizes other major findings and concludes, “It’s reasonable to choose LR to treat hyperkalemia over … Continue reading Is Lactated Ringer’s Solution Safe for Hyperkalemia Patients?