Lactated Ringer's Is Superior to Normal Saline in a Model of Massive Hemorrhage and Resuscitation

Abstract

With moderate hemorrhage, NS and LR are equivalent, but in the setting of massive hemorrhage and resuscitation, significantly more physiologic derangement and mortality occurs with NS than LR. LR is superior to NS for use in massive resuscitation.

The Impact of Pre-Hospital Administration of Lactated Ringer's Solution versus Normal Saline in Patients with Traumatic Brain Injury

“…Animal models of uncontrolled hemorrhagic shock have demonstrated that administration of LR resulted in improved physiological outcomes. [8][9][10] LR and NS may also have different effects on coagulation. 11,12 One animal study using a hemorrhagic shock model showed that resuscitation with LR was associated with decreased secondary bleeding.…”

Ringer’s lactate is compatible with the rapid infusion of AS-3 preserved packed red blood cells

“…3 Studies performed in animals have shown that treatment of hemorrhagic shock with NS, when compared to balanced salt solutions or RL, leads to an exacerbation of pre-existing acidosis and increased mortality. 4,16,17 This finding is significant in that acidosis is associated with impaired cardiac performance, decreased renal perfusion, and poor prognosis. 2,3 It has also been shown to increase perioperative blood loss and to raise the level of circulating inflammatory cytokines, such as tumour necrosis factor and interleukins 6 and 10.…”

“…18 Despite this, there is considerable evidence that the use of RL to treat massive blood loss leads to significantly less morbidity and mortality than the use of NS. 2,5,6,16,19 The CBS and AABB have long advised that only NS should be used to dilute PRBC. 9,10 These standards are based on laboratory research conducted more than 20 years ago that have demonstrated that calcium-containing crystalloids could cause clotting to occur when combined with warmed blood components preserved with CPDA.…”

Acute kidney injury in surgical patients

“…Several studies have demonstrated that, in comparison with more physiological solutions such as Hartmann's, even healthy subjects find it difficult to excrete solutions with a high chloride content such as 0.9% saline, which can cause hyperchloraemic acidosis and reduced glomerular filtration rate (GFR). 2,4,[89][90][91] For the injured or surgical patient it is even more difficult to excrete a salt and water load and to maintain normal serum osmolarity for several reasons.…”