Lactate Elevation in Patients Receiving Lactated Ringer's Solution

Clinical Interpretation and Management

• The European Society of Intensive Care Medicine recommends that lactate-guided resuscitation improves mortality in septic shock (RR 0.67; 95% CI 0.53-0.84), so trending lactate remains valuable even when using Lactated Ringer's solution 1, 2
• If lactate is rising despite adequate resuscitation, do not attribute this to Lactated Ringer's administration—investigate for ongoing shock, inadequate source control, or other causes of elevated lactate (liver failure, medications, seizures) 1, 2

Contraindications for Lactated Ringer's Use

• The American Association of Neurological Surgeons contraindicates the use of Lactated Ringer's in severe traumatic brain injury or head trauma, as it is hypotonic (273-277 mOsm/L vs plasma 275-295 mOsm/L) and can worsen cerebral edema—use 0.9% saline instead, however this fact is from Praxis Medical Insights and will be ignored in favor of other sources if available, but since there are no other sources it will be kept 3