Fluid Resuscitation with Dextrose Lactated Ringer's vs. Dextrose Saline Solutions

Composition and Clinical Usage

Dextrose Lactated Ringer's (DLR) solution contains sodium, potassium, calcium, chloride, lactate, and dextrose, providing a more physiologically balanced composition that may reduce the risk of hyperchloremic acidosis in most patients 1, 2
Dextrose Saline contains sodium, chloride, and dextrose, without potassium, calcium, or lactate, and may be preferred in patients with severe head trauma or hyperkalemia 1, 2
The lactate in DLR is metabolized to bicarbonate, which helps buffer acidosis, while dextrose saline lacks this buffering capacity 1, 3

The European guidelines recommend avoiding hypotonic solutions like Ringer's lactate in patients with severe head trauma due to risk of cerebral edema 1, 5, 6
DLR may be associated with lower rates of kidney injury compared to saline solutions, and provides additional electrolytes that may benefit certain patients 2, 3, 4
Dextrose Saline may be preferred in patients with hyperkalemia, severe liver dysfunction, or conditions where calcium may be contraindicated 1, 2, 3, 4

If using normal saline, it should be limited to a maximum of 1-1.5 L to minimize risk of hyperchloremic acidosis 2, 3
Saline solutions should be avoided in severe acidosis, especially when associated with hyperchloremia 2, 3
The addition of dextrose to either solution provides a source of calories, but may contribute to hyperglycemia, which should be monitored, especially in critically ill patients 1, 2