PlasmaLyte Composition and Clinical Considerations

Composition of PlasmaLyte

The American Academy of Pediatrics recommends using PlasmaLyte, a balanced crystalloid solution that contains 0 g/dL of glucose, as clearly indicated in clinical practice guidelines 1, 2, 3
PlasmaLyte contains electrolytes that closely mimic human plasma: sodium (140 mEq/L), potassium (5 mEq/L), chloride (98 mEq/L), magnesium (3 mEq/L) 1, 4
PlasmaLyte includes acetate (27 mEq/L) as a buffer 1, 4
PlasmaLyte has an osmolarity of 294 mOsm/L, making it near-isotonic 1, 3

PlasmaLyte is commonly used as an isotonic maintenance fluid or resuscitation fluid, according to the American Academy of Pediatrics 5, 4
When glucose administration is needed alongside PlasmaLyte, separate dextrose-containing solutions must be administered, as recommended by the American Academy of Pediatrics 5, 1
For pediatric patients requiring both isotonic fluids and dextrose, clinicians must use alternative solutions since PlasmaLyte with dextrose is not available in the US, as stated by the American Academy of Pediatrics 1, 5

The American Academy of Pediatrics recommends using standard PlasmaLyte if a balanced electrolyte solution without dextrose is needed 1
If both balanced electrolytes and dextrose are required, the American Academy of Pediatrics suggests using separate administration of PlasmaLyte and dextrose solution, or choosing an alternative solution like D5 lactated Ringer's 1, 5
For pediatric maintenance fluids, the American Academy of Pediatrics recommends following guidelines that suggest isotonic solutions with appropriate potassium chloride and dextrose 5, 6

For severe dehydration with shock or altered mental status, isotonic intravenous fluids including lactated Ringer's and normal saline (and by extension, balanced crystalloids like Plasmalyte) should be administered when oral rehydration solution (ORS) therapy fails or in the presence of ileus, as recommended by the Clinical Infectious Diseases guidelines 7, 8

In cases of severe head trauma or traumatic brain injury, the British Journal of Anaesthesia recommends using 0.9% saline as first-line, but notes that buffered isotonic solutions like Plasmalyte might be better than saline as they avoid hyperchloremic acidosis 9

For traumatic brain injury or severe head trauma, the British Journal of Anaesthesia recommends using 0.9% saline as first-line 9
For general resuscitation, severe dehydration, shock, the Clinical Infectious Diseases guidelines recommend using balanced crystalloids (Plasmalyte or lactated Ringer's) as first-line 7, 8