Compound solution of sodium lactate

Intravenous
Replacement of fluid and electrolytes

Severe: Contraindicated.

Severe: Contraindicated.

May form a ceftriaxone-Ca precipitate when given with ceftriaxone. Incompatible with amphotericin B and thiopental Na. May increase the risk of coagulation when administered with citrate anticoagulated/preserved blood preparations through the same administration set.

Hypersensitivity. Severe metabolic acidosis, metabolic alkalosis, conditions associated with increased lactate levels (e.g. lactic acidosis) or impaired lactate utilisation, CHF, hyperkalaemia, extracellular hyperhydration or hypervolaemia, ascitic cirrhosis. Severe hepatic and renal impairment. Concomitant use with ceftriaxone in neonates (≤28 days).

Patient with hypernatraemia, hyperchloraemia, hypercalcaemia, conditions predisposing to hypercalcaemia (e.g. granulomatous diseases associated with increased calcitriol synthesis such as sarcoidosis or Ca renal calculi), conditions predisposing to hyperkalaemia (e.g. adrenocortical insufficiency, acute dehydration, extensive tissue injury or burns), syndrome of inappropriate antidiuretic hormone (SIADH) secretion; type 2 diabetes mellitus, diabetes insipidus, cardiac disease, risk factors for alkalosis; conditions that may cause Na retention, fluid overload and oedema (e.g. primary hyperaldosteronism, pre-eclampsia). Patient receiving digitalis therapy. Not intended for the treatment of severe K deficiency. Mild to moderate renal and hepatic impairment. Children and elderly. Pregnancy and lactation.

Significant: Fluid or solute overload resulting in dilution of serum electrolyte concentrations, overhydration, congested states including pulmonary congestion and oedema; K and/or Na retention, electrolyte disturbances (e.g. hyperkalaemia), acid-base imbalance, worsened metabolic alkalosis; hypersensitivity reactions (e.g. angioedema, urticaria, pruritus).
Cardiac disorders: Chest tightness or pain with tachycardia or bradycardia.
General disorders and administration site conditions: Febrile response, infusion site reactions (e.g. inflammation, rash, erythema, pruritus, pain, burning sensation, phlebitis, venous thrombosis).
Respiratory, thoracic and mediastinal disorders: Cough, sneezing, nasal congestion, dyspnoea.

Monitor serum electrolyte levels (e.g. Na, K, Cl, Ca, bicarbonate), fluid balance, acid-base balance, and osmolarity during treatment; weight, input and output, and infusion site.

Symptoms: Fluid and Na overload with a risk of peripheral or pulmonary oedema (especially if renal Na excretion is impaired). Management: Symptomatic and supportive treatment.

Risk of Na and fluid retention may be increased with corticosteroids. May increase the risk of hyperkalaemia with K-sparing diuretics (e.g. spironolactone, amiloride), ACE inhibitors, angiotensin II receptor antagonists, tacrolimus, and ciclosporin. May increase the risk of hypercalcaemia with thiazide diuretics and vitamin D. Renal clearance of acidic drugs (e.g. barbiturates, salicylates, lithium) may be increased due to the alkalinisation of urine. Renal clearance of alkaline drugs (e.g. ephedrine, dexamphetamine) may be decreased. Concomitant use with agents that increase the vasopressin effect (e.g. chlorpropamide, carbamazepine, clofibrate, vincristine, SSRIs, antipsychotics, cyclophosphamide, NSAIDs, desmopressin, oxytocin) may increase the risk of hospital-acquired hyponatraemia.
Potentially Fatal: May cause the formation of ceftriaxone-Ca precipitates (particularly in the lungs and kidneys of neonates ≤28 days) when co-administered with ceftriaxone, even if separate infusion lines are used. May result in serious cardiac arrhythmia with digitalis glycosides.

Description:
Overview: Compound solution of sodium lactate is an isotonic sterile solution composed of Na chloride, K chloride, Ca chloride dihydrate, and Na lactate. The concentrations and calculated osmolarity of the electrolytes may vary among individual products or between countries (refer to specific individual products or local guidelines).
Mechanism of Action: Compound solution of sodium lactate is used for restoring electrolyte imbalance and water for hydration. Its main effect is the expansion of the extracellular compartment including both the interstitial and intravascular fluid. Additionally, its Na lactate content is converted into bicarbonate which acts as an alkalinising agent to normalise the pH of the acid-base balance of the body.
Synonym(s): Lactated Ringer's solution; Ringer's lactate solution; Hartmann's solution.
Pharmacokinetics:
Metabolism: Lactate component is metabolised in the liver via oxidation and gluconeogenesis to form bicarbonate.

Store between 20-25°C. Protect from excessive heat.

Intravenous & Other Sterile Solutions

Anon. Ringer's Injection (Lactated). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/07/2023.

B. Braun Compound Sodium Lactate Intravenous Infusion B.P. (B. Braun Medical Industries Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 05/07/2023.

Compound Sodium Lactate Solution for Infusion BP (Baxter Healthcare Ltd.). MHRA. https://products.mhra.gov.uk. Accessed 19/10/2023.

Fresenius Kabi New Zealand Limited. Compound Sodium Lactate (Hartmann's) Solution data sheet 08 Sep 2021. Medsafe. http://www.medsafe.govt.nz. Accessed 19/10/2023.

Joint Formulary Committee. Potassium Chloride with Calcium Chloride, Sodium Chloride and Sodium Lactate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/07/2023.

Lactated Ringers Solution (B. Braun Medical Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 19/10/2023.

Ringer Lactate. Medecins Sans Frontieres. https://medicalguidelines.msf.org. Accessed 29/08/2023.

Singh S, Kerndt CC, Davis D. Ringer's Lactate. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK500033. Accessed 29/08/2023.