What do you prefer - LR or NS?

[Limey-]

LR was used for years as the Lactate and electrolytes were 'supposed' to counter the acidotic state that results from shock.
There is no doubt that it will result in a more short term more alkalotic blood PH but at what cost??
A number of studies have shown that NS is superior in that it takes less volume to reverse shock with NS than LR. LR affects the clotting cascade negatively. LR is more prone to cause cerebral edema.
LR costs significantly more than NS with no advantage.
In multi Trauma patients requiring large transfusion and huge fluid resuscitation there are more arguments against LR than for it.

[Limey-]

BTW we carried LR for Burn Protocols...................different story.

[chuckman]

LR was used for years as the Lactate and electrolytes were 'supposed' to counter the acidotic state that results from shock.
There is no doubt that it will result in a more short term more alkalotic blood PH but at what cost??
A number of studies have shown that NS is superior in that it takes less volume to reverse shock with NS than LR. LR affects the clotting cascade negatively. LR is more prone to cause cerebral edema.
LR costs significantly more than NS with no advantage.
In multi Trauma patients requiring large transfusion and huge fluid resuscitation there are more arguments against LR than for it.

Use it, don't use it, change ad lib. That has been the official unofficial protocol for how many decades? Right now, I think ATLS is recommending LR. Anecdotally, I haven't seen a whit of difference in patient outcome between the two. But I do know neither will reverse shock, but I understand your point.

[Hmac]

The effects of NS vs LR would be highly unlikely to manifest themselves in the field or in the ER. As volume expanders for treating hypovolemia from hemorrhage, they'll be equivalent. The problems that one might theoretically see with Ringer's Lactate are going to manifest themselves in the ICU over the next few days, not pre-hospital. Anecdotally, I've never seen post-resuscitation problems that I could clearly attribute to use of one vs the other.




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[FL2011]

Came across this PDF from a EM residency program's journal club site:
Fluid Resuscitation: 0.9% Normal Saline vs Lactated Ringer's vs Albumin

[Abraxas]

I truly love this site. Where else can I get all this info in one place

[benthughes]

For trauma resuscitation I see no benefit of LR over NS as either will be used initially as volume replacements. As stated blood products shouldn't be given with LR. That in itself wins the argument in my book. In our transport environment LR is for pregnant women and NS for everyone else.

[Spike59]

As a paramedic in south Texas we dropped LR and only stock NS. It simplifies our IV selection to just 500 mls for medical situations and 1000 mls for trauma. Our medical directors felt that you did not get much benefit from LR in the pre-hospital setting. We use D25 pre-filled for peds and D50 pre-filled for adults. I agree with Abraxas that this is an outstanding site for info. EMS Paramedic for 17 years!

[parishioner]

For trauma resuscitation I see no benefit of LR over NS as either will be used initially as volume replacements. As stated blood products shouldn't be given with LR. That in itself wins the argument in my book. In our transport environment LR is for pregnant women and NS for everyone else.

Yea, I see LR given mainly in the L&D unit before a spinal or epidural due to the risk of hypotension with those procedures. Everywhere else in the hospital, its NS.

[citizensoldier16]

I'm a paramedic in NC. For the most part, 0.9% NS should be used for fluid replacement. Every ambulance in my county carries only NS. NS is good for rapid fluid replacement as well as maintenance fluid resuscitation.

LR on the other hand, should be used only in major trauma with significant blood loss, burns, or severe acidosis. LR is usually used for a short period of time because it is too high in sodium and too low in potassium compared to the homeostatic balance of the body. It can create an electrolyte imbalance if used for long periods of time (ie, more than 1000mL infused).

NS is good for treatment of dehydration if the Pt is unable to take in PO fluids fast enough or effectively enough.

In short, LR used for major trauma or burns. NS used for fluid resuscitation or maintenance fluid.

Source: Aehlert, Barbara, Paramedic Practice Today, Vol. 1