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Lactated Ringers And Lactic Acidosis

Effects Of Intravenous Lactated Ringers Solution In Cowssuffering From Hepatic Disorders

Effects Of Intravenous Lactated Ringers Solution In Cowssuffering From Hepatic Disorders

Effects of Intravenous Lactated Ringers Solution in CowsSuffering from Hepatic Disorders Background: This study investigated changes in the blood acid-base balance to determine the effects of Lactated Ringers Solution (LRS) administration in a steer with liver damage caused by carbon tetrachloride (CCl4) administration and in a cow with a fatty liver caused by a parturient negative energy balance. Materials and Methods: The LRS was administered to the CCl4 steer before CCl4 administration and 2, 7 and 11 days after CCl4 administration. The fatty liver cow and a group of control cows were administered LRS once. The initiation of LRS infusion was designated time-point 0. Venous blood samples were collected periodically from time-point 0-360 min thereafter and parameters related to the acid-base balance were measured. Results: On day 2, blood pH of the CCl4 steer before LRS administration was 7.26 but it gradually increased after the initiation of LRS administration, before ultimately recovering to within the normal reference range. The HCO3 levels decreased transiently just after the administration of LRS on day 7, then rapidly returned normal. Despite the fatty liver cow having severe fat infiltration, there were no substantial differences in parameters related to the blood acid-base balance between the fatty liver cow and the control cows, after LRS administration. Conclusion: Even in a steer suffering from liver damage caused by CCl4 administration, lactate was metabolised in the liver and worked as an alkaliser. Therefore, LRS may be a safe extracellular replacement solution when administered at the recommended flow rate and dose (20 mL kg1 h1 and 30 mL kg1, respectively) to dairy cows in clinics. How to cite this article: Ken Onda, Chikako Noda, Kazue Nakamura, Reii Continue reading >>

Newsletter: D-lactic Acidosis

Newsletter: D-lactic Acidosis

AddthisShare | Facebook Twitter Pinterest Gmail var addthis_exclude = 'print, email'; D-Lactic Acidosis Craig Petersen RD, CNSC D-lactic acidosis, also referred to as D-lactate encephalopathy, is a rare neurological syndrome that can occur in individuals with short bowel syndrome (SBS) or following jejuno-ileal bypass surgery. A home parenteral or enteral nutrition (HPEN) consumer may develop the neurological symptoms—which can be quite striking—several months to years after the initial diagnosis of a malabsorption disorder. Misdiagnosis of D-lactic acidosis is common, as the neurologic symptoms are sometimes attributed to other causes. With proper diagnosis, D-lactic acidosis can be treated promptly and the symptoms will usually resolve within several hours to a few days. Symptoms Neurological symptoms associated with this syndrome typically present after the ingestion of enteral formula or food high in carbohydrates (either simple or complex) and include altered mental status, slurred speech, confusion, disorientation, difficulty concentrating, memory deficits, excessive sleepiness, weakness, abnormal gait, problems with muscle coordination, and even coma. Individuals with D-lactic acidosis often appear to be inebriated, or drunk, though they may not have consumed alcohol and alcohol is not detected in the blood. Behavior during episodes of D-lactic acidosis can be aggressive, hostile, or abusive. Neurological symptoms are episodic and may last from hours to days. They are accompanied by metabolic acidosis and elevation of plasma D-lactic acid (also referred to as D-lactate) concentration. Cause In D-lactic acidosis, carbohydrate that is not properly absorbed is fermented by an abnormal bacterial flora in the colon. This fermentation produces excessive amounts of Continue reading >>

L-lactate And D-lactate - Clinical Significance Of The Difference

L-lactate And D-lactate - Clinical Significance Of The Difference

L-lactate and D-lactate - clinical significance of the difference L-lactate and D-lactate - clinical significance of the difference Modern blood gas analyzers often have incorporated sensor technology that allows measurement of plasma lactate concentration. In nature lactate exists in two isoforms: L-lactate and D-lactate. In all vertebrates, including humans, the L-lactate form is by far the most abundant and pathophysiologically significant, and it is this form that is specifically measured by the lactate sensors in blood gas analyzers and indeed all routine methods used to measure lactate in the clinical laboratory. The main focus of this brief review is physiological and pathological aspects that distinguish L-lactate and D-lactate. Consideration will be given to the very rare instance when measurement of blood D-lactate is clinically useful and just why the lactate sensor in blood gas analyzers is not useful in such rare circumstance. Lactate, the anion that results from dissociation of lactic acid, is an intracellular metabolite of glucose; specifically it is the end product of anaerobic glycolysis, the final step of which is conversion of pyruvate to lactate by the enzyme lactate dehydrogenase. In health around 1500 mmol of lactate is produced daily and so long as normal rate of metabolic disposal - principally by the liver and kidneys - is maintained, blood plasma concentration remains within the approximate reference range of 0.5-1.5 mmol/L [1]. Abnormal increase in plasma lactate (called hyperlactatemia) occurs if the rate of production exceeds the rate of disposal. If hyperlactatemia is sufficiently severe (plasma lactate >5.0 mmol/L), it is associated with acidosis (blood pH <7.35). The condition is then called lactic acidosis. There are many causes of hype Continue reading >>

Lactated Ringer's Solution

Lactated Ringer's Solution

Christer Svensn, Peter Rodhe, in Pharmacology and Physiology for Anesthesia , 2013 Ringer's solutions are either called lactated or acetated Ringer's solutions, named for a British physiologist, or Hartmann's solution, named for a U.S. pediatrician who in the 1930s added lactate as a buffer to prevent acidosis in septic children.114,116 In the United States and worldwide, mainly lactated Ringer's (LR), or Hartmann's solution as it is called in the United Kingdom, is used (see Table 33-2) as the initial crystalloid for resuscitation and for perioperative maintenance. The buffer ion in acetated Ringer's (AR) is acetate, which is mostly used in Scandinavia. While both ions are metabolized to bicarbonate, acetate is more quickly metabolized.117 Lactate is metabolized in the liver and kidneys while acetate is metabolized in most tissues. Furthermore, lactate requires more oxygen for metabolism and causes a slight increase in plasma glucose, providing a theoretical advantage for the acetated Ringer's solution.118 Ringer's solutions are the fluids of choice for almost every situation. Although they are slightly hypotonic and low caloric, few side effects are observed. All Ringer's solutions are slightly vasodilatory and inflammatory. They distribute from the plasma to the interstitium in approximately 25 to 30 minutes with a distribution half-time of approximately 8 minutes.98 However, this is a static concept of distribution. The fluid load is either readily eliminated or distributed to the interstitium. The volume effect of a crystalloid such as LR could be substantial depending on the effects of anesthesia, surgery, trauma, and hemorrhage.83 However, the concept of calculating volume effects based on hemoglobin dilution (hematocrit dilution) is sometimes challenged by rese Continue reading >>

Lactic Acidosis Treatment & Management: Approach Considerations, Sodium Bicarbonate, Tromethamine

Lactic Acidosis Treatment & Management: Approach Considerations, Sodium Bicarbonate, Tromethamine

Author: Kyle J Gunnerson, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, MCCM more... Treatment is directed towards correcting the underlying cause of lactic acidosis and optimizing tissue oxygen delivery. The former is addressed by various therapies, including administration of appropriate antibiotics, surgical drainage and debridement of a septic focus, chemotherapy of malignant disorders, discontinuation of causative drugs, and dietary modification in certain types of congenital lactate acidosis. Cardiovascular collapse secondary to hypovolemia or sepsis should be treated with fluid replacement. Both crystalloids and colloids can restore intravascular volume, but hydroxyethyl starch solutions should be avoided owing to increased mortality. [ 21 ] Excessive normal saline administration can cause a nongap metabolic acidosis due to hyperchloremia, which has been associated with increased acute kidney injury. [ 32 ] Balanced salt solutions such as Ringer lactate and Plasma-Lyte will not cause a nongap metabolic acidosis and may reduce the need for renal replacement therapy; however, these can cause a metabolic alkalosis. [ 33 ] No randomized, controlled trial has yet established the safest and most effective crystalloid. If a colloid is indicated, albumin should be used. Despite appropriate fluid management, vasopressors or inotropes may still be required to augment oxygen delivery. Acidemia decreases the response to catecholamines, and higher doses may be needed. Conversely, high doses may exacerbate ischemia in critical tissue beds. Careful dose titration is needed to maximize benefit and reduce harm. Lactic acidosis causes a compensatory increase in minute ventilation. Patients may be tachypneic initially, but respiratory muscle fatigue can ensue rapidly a Continue reading >>

Clinical Review: Acidbase Abnormalities In The Intensive Care Unit

Clinical Review: Acidbase Abnormalities In The Intensive Care Unit

Clinical review: Acidbase abnormalities in the intensive care unit Acidbase abnormalities are common in the critically ill. The traditional classification of acidbase abnormalities and a modern physico-chemical method of categorizing them will be explored. Specific disorders relating to mortality prediction in the intensive care unit are examined in detail. Lactic acidosis, base excess, and a strong ion gap are highlighted as markers for increased risk of death. acidbase disordersbase excesslactic acidosismetabolic acidosisstrong ion gap Deranged acidbase physiology drives admission to a critical care arena for vast numbers of patients. Management of diverse disorders ranging from diabetic ketoacidosis to hypoperfusion with lactic acidosis from hemorrhagic or septic shock shares a variety of common therapies for disordered acidbase balance. It is encumbent upon the intensivist to decode the deranged physiology and to categorize the disorder in a meaningful fashion to direct effective repair strategies [ 1 ]. Besides the traditional classification of respiratory versus metabolic, acidosis versus alkalosis, and gap versus nongap (normal gap), the intensivist benefits from classifying acidbase disorders into three discrete groups: iatrogenically induced (i.e. hyperchloremic metabolic acidosis), a fixed feature of a pre-existing disease process (i.e. chronic renal failure, hyperlactatemia), or a labile feature of an evolving disease process (i.e. lactic acidosis from hemorrhage, shock of any cause). The therapy for, and the outcome from, each of these three categories may be distinctly different. A review of the genesis of acidbase abnormalities is appropriate but will be limited to metabolic derangements, as respiratory acidbase abnormalities are usually reparable with ad Continue reading >>

Ringer's Lactate Solution

Ringer's Lactate Solution

Side effects may include allergic reactions , high blood potassium , volume overload , and high blood calcium . [2] It may not be suitable for mixing with certain medications and some recommend against use in the same infusion as a blood transfusion . [4] Ringer's lactate solution has a lower rate of acidosis as compared with normal saline . [1] [4] Use is generally safe in pregnancy and breastfeeding . [2] Ringer's lactate solution is in the crystalloid family of medication. [5] It is the same tonicity as blood . [2] Ringer's solution was invented in the 1880s with lactate being added in the 1930s. [4] It is on the World Health Organization's List of Essential Medicines , the most effective and safe medicines needed in a health system . [6] Lactated Ringer's is available as a generic medication . [1] The wholesale cost in the developing world is about 0.60 to 2.30 USD per liter. [7] For people with poor liver function , Ringer's acetate may be a better alternative with the lactate replaced by acetate . [8] In Scandinavia Ringer's acetate is typically used. [9] Ringer's lactate solution is very often used for fluid resuscitation after a blood loss due to trauma , surgery , or a burn injury .[ citation needed ] Ringer's lactate solution is used because the by-products of lactate metabolism in the liver counteract acidosis , which is a chemical imbalance that occurs with acute fluid loss or renal failure. [10] The IV dose of Ringer's lactate solution is usually calculated by estimated fluid loss and presumed fluid deficit. For fluid resuscitation the usual rate of administration is 20 to 30 ml/kg body weight/hour. RL is not suitable for maintenance therapy (i.e., maintenance fluids) because the sodium content (130 mEq/L) is considered too low, particularly for children, Continue reading >>

Clinical Use Of Lactate Monitoring In Critically Ill Patients

Clinical Use Of Lactate Monitoring In Critically Ill Patients

Bakker et al.; licensee Springer.2013 Increased blood lactate levels (hyperlactataemia) are common in critically ill patients. Although frequently used to diagnose inadequate tissue oxygenation, other processes not related to tissue oxygenation may increase lactate levels. Especially in critically ill patients, increased glycolysis may be an important cause of hyperlactataemia. Nevertheless, the presence of increased lactate levels has important implications for the morbidity and mortality of the hyperlactataemic patients. Although the term lactic acidosis is frequently used, a significant relationship between lactate and pH only exists at higher lactate levels. The term lactate associated acidosis is therefore more appropriate. Two recent studies have underscored the importance of monitoring lactate levels and adjust treatment to the change in lactate levels in early resuscitation. As lactate levels can be measured rapidly at the bedside from various sources, structured lactate measurements should be incorporated in resuscitation protocols. Lactate LevelTissue HypoxiaBlood Lactate LevelLactate ClearanceMicrocirculatory Perfusion Many variables measured in critically ill patients have been used to estimate severity of disease, prognosticate morbidity and mortality, evaluate costs of treatment, and finally indicate specific treatment and monitor the adequacy of treatment and its timing. It is unlikely that one measurement can replace all of these, but in the remainder of this manuscript we will show that lactate levels may come close. Although in our mind strongly linked to tissue hypoxia, lactate levels follow many more metabolic processes not related to tissue hypoxia and, therefore, subject to many disturbances found in various clinical situations. The first descript Continue reading >>

In Sepsis, Fluid Choice Matters

In Sepsis, Fluid Choice Matters

You are at: Home Research In Sepsis, Fluid Choice Matters During a large-volume sepsis resuscitation, your choice of fluids specially which crystalloid solution could mean the difference between life, death and dialysis Included in the emergency physicians skill set is their ability to resuscitate critically ill patients; an example of this is the emergency department care of the septic patient. Given the general delay in translating medical knowledge to the bedside, its remarkable to see the vast change in the management of these patients since Dr. Rivers published his ground-breaking paper [ 1 ]. In a relatively short period of time, weve made aggressive fluid resuscitation and early antibiotics the standard of care and now focus our attention on improving other aspects of the resuscitation. Recent literature has studied goal MAP requirements [ 2 ], endpoints such as lactate clearance vs ScvO2 [ 3 ], and how best to evaluate volume responsiveness (IVC measurement [ 4 ], passive leg raise [ 5 ], carotid velocity time integral [ 6 ]). One element that has received far less attention is the type of fluid that is administered during the resuscitation. As it turns out, the type of fluid you choose does matter; it may be the difference between your patient requiring dialysis or even dying. Specifically, which crystalloid solution should be your fluid of choice in patients requiring large-volume resuscitations, such as those with sepsis or diabetic ketoacidosis? There are different types of crystalloid fluids. Crystalloids such as lactated ringers (LR) or PlasmaLyte are considered balanced fluids, while chloride-rich fluids such as normal saline (NS) are not. Colloids including albumin and starches are not considered in this discussion. What makes some fluids balanced and o Continue reading >>

Why Do We Use Ringers Lactate To Treat Shock? - Quora

Why Do We Use Ringers Lactate To Treat Shock? - Quora

Why do we use Ringers lactate to treat shock? Answered May 23, 2017 Author has 507 answers and 324.7k answer views Lactated Ringers Solution is actually a more balanced crystalloid solution than is normal saline. Therefore, when you have to infuse large volumes of fluid quickly, as is the case when resuscitating hypotensive septic or extremely dehydrated patients, LR is a better choice. Large amounts of NS can result in a hyperchloremic metabolic acidosis. It turns out that the sodium isn't the problem, but rather the chloride. This means that NS is out of balance with the chloride levels in the body. If you're just infusing small volumes, it's likely not going to be an issue whether you choose LR or NS. However, one might give more thought to certain patient populations, such as dialysis patients, perhaps. Here's an article that discusses the issues as well as several studies addressing this: In Sepsis, Fluid Choice Matters - Emergency Physicians Monthly I used to work in the ER, and conventional wisdom when I started was that LR was better than NS for any hypovolemic resuscitation. But then LR was a bit more expensive than NS, and the pharmacists determined that there really was little difference between NS and LR. The one concern was that indiscriminate amounts of LR could cause a metabolic alkalosis from the lactate, something I didn't see discussed in the above article. In any event, we were encouraged to order NS, and, eventually, LR was removed from the Pyxis altogether. And now the pendulum has swung back the other way. Best practice favors LR for septic shock resuscitation currently, but it looks like there's room for additional studies. It's certain that hyperchloremic metabolic acidosis is a very real concern, especially in septic patients, who already tend Continue reading >>

Lactic Acidosis Treatment & Management

Lactic Acidosis Treatment & Management

Approach Considerations Treatment is directed towards correcting the underlying cause of lactic acidosis and optimizing tissue oxygen delivery. The former is addressed by various therapies, including administration of appropriate antibiotics, surgical drainage and debridement of a septic focus, chemotherapy of malignant disorders, discontinuation of causative drugs, and dietary modification in certain types of congenital lactate acidosis. Cardiovascular collapse secondary to hypovolemia or sepsis should be treated with fluid replacement. Both crystalloids and colloids can restore intravascular volume, but hydroxyethyl starch solutions should be avoided owing to increased mortality. [21] Excessive normal saline administration can cause a nongap metabolic acidosis due to hyperchloremia, which has been associated with increased acute kidney injury. [32] Balanced salt solutions such as Ringer lactate and Plasma-Lyte will not cause a nongap metabolic acidosis and may reduce the need for renal replacement therapy; however, these can cause a metabolic alkalosis. [33] No randomized, controlled trial has yet established the safest and most effective crystalloid. If a colloid is indicated, albumin should be used. Despite appropriate fluid management, vasopressors or inotropes may still be required to augment oxygen delivery. Acidemia decreases the response to catecholamines, and higher doses may be needed. Conversely, high doses may exacerbate ischemia in critical tissue beds. Careful dose titration is needed to maximize benefit and reduce harm. Lactic acidosis causes a compensatory increase in minute ventilation. Patients may be tachypneic initially, but respiratory muscle fatigue can ensue rapidly and mechanical ventilation may be necessary. Alkali therapy remains controversial Continue reading >>

Effects Of Intravenous Lactated Ringers Solution In Cowssuffering From Hepatic Disorders - Scialert Responsive Version

Effects Of Intravenous Lactated Ringers Solution In Cowssuffering From Hepatic Disorders - Scialert Responsive Version

Effects of Intravenous Lactated Ringers Solution in CowsSuffering from Hepatic Disorders Effects of Intravenous Lactated Ringers Solution in CowsSuffering from Hepatic Disorders Ken Onda , Chikako Noda , Kazue Nakamura , Reiichiro Sato , Hideharu Ochiai , Sachiko Arai , Hiroo Madarame , Kazuhiro Kawai and Fujiko Sunaga Background: This study investigated changes in the blood acid-base balance to determine the effects of Lactated Ringers Solution (LRS) administration in a steer with liver damage caused by carbon tetrachloride (CCl4) administration and in a cow with a fatty liver caused by a parturient negative energy balance. Materials and Methods: The LRS was administered to the CCl4 steer before CCl4 administration and 2, 7 and 11 days after CCl4 administration. The fatty liver cow and a group of control cows were administered LRS once. The initiation of LRS infusion was designated time-point 0. Venous blood samples were collected periodically from time-point 0-360 min thereafter and parameters related to the acid-base balance were measured. Results: On day 2, blood pH of the CCl4 steer before LRS administration was 7.26 but it gradually increased after the initiation of LRS administration, before ultimately recovering to within the normal reference range. The HCO3 levels decreased transiently just after the administration of LRS on day 7, then rapidly returned normal. Despite the fatty liver cow having severe fat infiltration, there were no substantial differences in parameters related to the blood acid-base balance between the fatty liver cow and the control cows, after LRS administration. Conclusion: Even in a steer suffering from liver damage caused by CCl4 administration, lactate was metabolised in the liver and worked as an alkaliser. Therefore, LRS may be a saf Continue reading >>

Effect Of Intravenous Lactated Ringer's Solution Infusion On The Circulatinglactate Concentration: Part 3. Results Of A Prospective, Randomized,double-blind, Placebo-controlled Trial.

Effect Of Intravenous Lactated Ringer's Solution Infusion On The Circulatinglactate Concentration: Part 3. Results Of A Prospective, Randomized,double-blind, Placebo-controlled Trial.

1. Crit Care Med. 1997 Nov;25(11):1851-4. Effect of intravenous lactated Ringer's solution infusion on the circulatinglactate concentration: Part 3. Results of a prospective, randomized,double-blind, placebo-controlled trial. Didwania A(1), Miller J, Kassel D, Jackson EV Jr, Chernow B. (1)Department of Medicine, Johns Hopkins University/Sinai Hospital Program in Internal Medicine, Baltimore, MD 21215-5271, USA. Comment in Crit Care Med. 1997 Nov;25(11):1780-1. OBJECTIVES: We previously discovered that small amounts of lactated Ringer'ssolution, which are inadequately cleared from an intravenous catheter, falselyincrease the circulating lactate concentration in blood samples collected fromthat catheter. That finding prompted us to test the hypothesis that intravenouslactated Ringer's solution, infused at a rate used in resuscitation, wouldincrease the circulating lactate concentration.DESIGN: A prospective, randomized, double-blinded, placebo-controlled study.SETTING: A critical care research laboratory.SUBJECTS: Twenty-four normal, healthy, adult volunteer subjects.INTERVENTIONS: Two intravenous catheters were placed. One was used for theinfusion of the test solution and the other catheter was used for blood sampling.Blood samples were serially collected for the determination of blood lactateconcentrations.MEASUREMENTS AND MAIN RESULTS: Twenty-four healthy adult volunteers wererandomized to receive a 1-hr infusion of either lactated Ringer's solution (n =6), 0.9% saline (n = 6), 5% dextrose in lactated Ringer's solution (D5RL) (n =6), or 5% dextrose in water (D5W) (n = 6). Each subject received nothing by mouthafter midnight. At 0800 hrs, catheters were inserted and each subject received 1 L of the assigned solution over 1 hr. Throughout the study, the subjects were at Continue reading >>

Fluid Resuscitation

Fluid Resuscitation

Normal saline can cause a hyperchloremic metabolic acidosis, whereas lactated ringers can cause a metabolic alkalosis secondary to metabolism of lactate (which produces bicarbonate). Never use LR with blood products as the calcium will bind to the citrate. Dextrose-containing solutions should be avoided in patients with neurologic injuries as they may cause hyperglycemia, cerebral acidosis, and an osmotic diuresis [Stoelting et. al. Basics of Anesthesia, 5th ed. Elsevier China, p. 351, 2007]. It is well established that hypotonic fluids cause brain edema (thus do not use Lactated ringers for large volume resuscitation), although animal studies suggest that crystalloids increase cerebral edema and ICP only when they result in hypoosmolality [Crit Care Med 16: 862, 1988; Anesthesiology 67: 936, 1987] Half-life of albumin is 16 hours. Hydroxyethyl starch is made of either 6% MW hetastarch in saline [Hespan] or 6% MW hetastarch in balanced salt solution [Hextend]. 90% of hydroxylethyl starch particles last 17 days. Dextran comes in dextran 40 and dextran 70. Larger particles have a half-life in the order of days, thus dextran 70 is generally used for volume resuscitation, while dextram 40 is used to improve blood flow to the microcirculation. Hypersensitivity reactions to colloids are possible, but rare. Note that the dextrans can reduce platelet aggregation and adhesiveness, and that hydroxyethyl starch can reduce factor VIII and vWF, as mentioned in Barrons review of 113 studies (which stated Artificial colloid administration was consistently associated with coagulopathy and clinical bleeding, most frequently in cardiac surgery patients receiving hydroxyethyl starch) [Barron ME et. al. Arch Surg 139: 552, 2004]. All colloids share the following potential downsides volume Continue reading >>

Lactated Ringers And Lactate Clearance

Lactated Ringers And Lactate Clearance

SDN members see fewer ads and full resolution images. Join our non-profit community! I often get asked if lactated ringers worsens lactic acidosis... I've been told that lactated ringers will worsen lactic acidosis in liver failure... I've been asked if the lactate in lactated ringers will "falsely" elevate lab values. Personally, this is my go to crystalloid. Plasmalyte would be my only choice if it didnt cost 2-3x as much as LR. I know the answers to the above but would like to hear your thoughts. Now with lactate being the new marker for adequate resuscitation in sepsis I think its a good topic. I often get asked if lactated ringers worsens lactic acidosis... I've been told that lactated ringers will worsen lactic acidosis in liver failure... I've been asked if the lactate in lactated ringers will "falsely" elevate lab values. Personally, this is my go to crystalloid. Plasmalyte would be my only choice if it didnt cost 2-3x as much as LR. I know the answers to the above but would like to hear your thoughts. Now with lactate being the new marker for adequate resuscitation in sepsis I think its a good topic. Yes, it can falsely elevate serum lactate numbers and it it definitely more pronounced in bad livers. And I don't know why you'd use LR or Plasmalyte instead of NS for just about anything (unless of course you have stock in Baxter) Just be clear, I'm not saying using LR or plasmalyte is wrong - I just don't see the point I look @ the base labs, if they aren't already hyperchloremic ill start with NS, which I use for the 20mL/kg bolus, I tend to use LR for the second set of bolus, which comes after when I draw the lactic. I don't tend to redrawn lactic ~6 hour mark. Anecdotally it's I've not had many lactic acids bump but I know the LR can confound the data but is Continue reading >>

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