Products
Ringer’s solutions are commercially available in many countries as infusion solutions from various manufacturers (e.g., Braun, Bichsel, Fresenius). Irrigation solutions for wound treatment are also available. The solutions are named after the English physician and pharmacologist Sidney Ringer (1835-1910), who discovered in 1883 that the addition of calcium to a saline solution maintains the activity of frog hearts. To this day, Ringer’s mixture of the salts sodium chloride, potassium chloride, sodium hydrogen carbonate and calcium chloride continues to be used, albeit in modified form.
Ingredients
Pure Ringer’s solutions contain sodium, potassium, calcium, chloride, and hydrogen carbonate in water for injection. In addition, preparations with the following additives are also commercially available:
- Lactate (lactic acid): Ringer’s lactate solution.
- Acetate (acetic acid): Ringer’s acetate solution.
- Acetate + malate (malic acid) advantage over lactate: metabolism independent of kidney and liver.
- Glucose
- Magnesium
Solutions “without carbonate” do not contain hydrogen carbonate.
Effects
Ringer’s solutions (ATC B05BB01) have a composition comparable to blood plasma and the extracellular fluid. Exchange with the extracellular space occurs within approximately 30 minutes. The solutions are intended to restore and maintain normal osmotic conditions. Acetate, lactate and malate have a basic effect. Glucose is an energy carrier to correct carbohydrate deficiency.
Indications
For the supply of electrolytes and water, as a fluid substitute, as a carrier solution for pharmaceutical agents. Irrigation solutions are also available for cleansing wounds. The addition of acetate, lactate and malate is used to correct mild metabolic acidosis (low blood pH).
Dosage
According to the drug label. Solutions are administered intravenously and dosed individually.
Contraindications
Ringer’s solutions are contraindicated in hyperhydration. They should not be used in hypertensive dehydration, hypernatremia, hyperkalemia, hyperchloremia, severe renal insufficiency, and decompensated heart failure. Refer to the drug label for complete precautions.
Interactions
There is an increased risk of fluid retention with cardiac decompensation when glucocorticoids and ACTH are administered concomitantly. Potassium salts, potassium-sparing diuretics, and inhibitors of the renin-angiotensin system may cause hyperkalemia.
Adverse effects
Ringer’s solutions are usually well tolerated. As with other infusions, possible adverse effects include venous irritation and thrombophlebitis.
