Hartmanns solution (Ringers lactate) 💊
Related Subjects:
|Respiratory Failure
|Non-invasive ventilation (NIV)
|Haemodialysis
|Dobutamine
About:
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- A crystalloid solution developed by physiologist Sidney Ringer in 1882 for cardiac experiments.
- Known in the UK as Hartmann’s solution (Ringer’s lactate in other countries).
- Widely used in perioperative fluid therapy, trauma, sepsis, and burns. Preferred by many anaesthetists over 0.9% saline to avoid hyperchloraemic acidosis.
- Isotonic, glucose-free, and helps maintain both volume and electrolytes.
Contents (approximate)
- Sodium: 131 mmol/L
- Chloride: 111 mmol/L
- Potassium: 5 mmol/L
- Calcium: 2 mmol/L
- Lactate: 29 mmol/L (metabolised to bicarbonate in liver)
- pH: ~6.5
- Osmolarity: ~273 mOsm/L
Indications
- Fluid resuscitation in trauma, sepsis, and burns.
- Maintenance fluids in patients who are nil by mouth (NBM).
- Correction of metabolic acidosis (via lactate → bicarbonate conversion).
- Intra- and post-operative fluid replacement.
Dose
- Dependent on indication (resuscitation vs. maintenance vs. replacement).
- Typical adult resuscitation bolus: 500 mL IV over 15–30 minutes, reassess and repeat if required.
- Maintenance fluid: usually 25–30 mL/kg/day total fluids (combined with potassium supplementation as needed).
- Always follow local hospital protocol and NICE guidance.
Interactions
- ⚠️ Incompatible with some IV additives (e.g., methylprednisolone, nitroglycerin, nitroprusside, norepinephrine). Always check compatibility before co-administration.
- Calcium content makes it incompatible with citrated blood transfusions - may cause clotting.
Contraindications
- Severe liver dysfunction: Impaired lactate metabolism → risk of lactic acidosis.
- Hyperkalaemia or hypercalcaemia: Due to electrolyte content.
- Severe metabolic or respiratory alkalosis: May worsen alkalosis.
- Renal impairment or heart failure: Risk of fluid overload.
Side Effects
- Lactate rise: usually mild and not clinically significant in those with normal liver function.
- Fluid overload - especially in patients with CHF or CKD.
- Electrolyte disturbances - monitor potassium and calcium in high-volume infusions.
- Local phlebitis at infusion site (rare).
