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Electrolyte Solutions

- RINGOLACT-D

(Lactated Ringer’s and 5% Dextrose Injection U.S.P)

Therapeutic Class

Isotonic crystalloid solution and carbohydrate source.

Description and Composition

a:2:{s:7:"English";s:617:"

A clear, colorless solution, each 1000 ml. of which contains:
Calcium Chloride 2H2O	0.2 grams
Potassium Chloride	0.3 grams
Sodium Chloride	6.0 grams
Sodium Lactate	3.1 grams
Dextrose Monohydrate	50.0 grams
Water for Injections q.s.

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Indications

a:2:{s:7:"English";s:511:"

Hypovolemic states such as those induced by severe diarrhea and vomiting.

Trauma and burns.

Environmental emergencies such as severe perspiration leading to dehydration and heat illness.

Also indicated for the prevention and replenishment of extracellular fluid before, during and after surgery.

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Dosage and Administration The dose is dependent upon the age, weight and clinical condition of the patient.
Rehydration Therapy: In severe cases of diarrhea and vomiting, Ringer’s Lactate (Ringolact) is indicated for the initial therapy and should be administered in a bolus dose of 20-30 ml/Kg.
Burns: When treating burned patients, the Parkland burn formula can be used.
Parkland Formula: 4ml x %Burn x Weight (kg)
50% of this amount should be given over the 1st 8 hours post burn and the rest over the next 16 hours.
Hemorrhage: Fluid resuscitation with Lactated Ringer’s Injection for blood loss requires 3ml. of Lactated Ringer’s Injection for every 1ml. of blood loss. Duration of Action and Excretion Passes out of the blood stream quite rapidly, especially when normal renal function and renal blood flow are present. It is a balanced salt solution and when infused about 25% is retained in the ECF. Adverse Effects

Fluid overload.
Congestive heart failure.

Contraindications

Congestive heart failure.
Renal failure.

Precautions

Care is required in patients with cardiac failure and severe liver damage and in cases where salt intake is restricted as the solution contains sodium chloride 6.0 grams/Liter and sodium lactate 3.1 grams/Liter.
Caution should be exercised in patients with hypertonic dehydration, alkalosis and those having disturbances of lactic acid metabolism.
Monitor E.C.G. continuously.
Frequently monitor blood pressure, pulse rate and respiratory rate.
Frequently auscultate breath sounds for rales.

Tonicity and Osmolarity

Isotonic solution having a tonicity of 137.
Isosmotic solution (272 mOsm/L)
(Although the tonicity and osmolarity are slightly less, nevertheless Ringer’s Lactate is considered to be isotonic and isosmotic).

Caloric Value Nil Pharmaceutical Precautions

Lactated Ringer’s Injection should not be mixed with citric acid added blood, and preparations containing phosphoric acid or carbonic acid, as the calcium content of this solution may form precipitates with these acids.
Store at room temperature. Protect from sunlight.
Do not use if bottle is leaking, solution is cloudy or contains foreign matter.
Discard unused portion.
Keep all medicines out of the reach of children.

Packaging 500ml and 1000ml in Plabottle.

Pharmacological Effects

a:2:{s:7:"English";s:2402:"

5% Dextrose and Lactated Ringer’s Injection has an electrolyte composition and concentration similar to that of the extracellular fluid along with added dextrose which acts as a caloric source. In stressful situations, e.g. surgery, provision of dextrose prevents gluconeogenesis, which otherwise occurs due to catabolism of fats and proteins. Provides calories for some metabolic needs. Each 100mL provides 5 grams of Dextrose and each gram of Dextrose Monohydrate provides 3.4kCal. Depending on the presence of insulin, glucose enters cells and is broken down to pyruvate. With adequate oxygen, it enters the Kreb's cycle in the mitochondria and is converted into energy (A.T.P.), CO2 and H2O. The brain does not require insulin for glucose metabolism. Even large volumes of infusion of the solution do not easily cause sodium excess and hyperchloremic acidosis. It expands circulating blood volume by approximating the fluid and electrolyte composition of the blood along with providing energy. Provides the following electrolytes in each liter of fluid:
Sodium	130 mEq.
Chloride	108.7 mEq.
Potassium	4 mEq.
Calcium	2.7 mEq.
Bicarbonate(as Lactate)	28 mEq.
Lactate is metabolized by the liver and converted to bicarbonate. One mole of lactate is metabolized in the body to produce one mole of bicarbonate. Therefore its administration has the same effect as that of bicarbonate. The presence of lactate not only eliminates any chances of dilutional acidosis, but also aids in the correction of mild acidosis. The infusion of 5% Dextrose and Ringer’s Lactate, does not induce hypokalemia and hypocalcemia as compared to normal saline. The pH range is 3.5 - 6.5.

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Pharmacological Effects

a:2:{s:7:"English";s:2402:"

5% Dextrose and Lactated Ringer’s Injection has an electrolyte composition and concentration similar to that of the extracellular fluid along with added dextrose which acts as a caloric source. In stressful situations, e.g. surgery, provision of dextrose prevents gluconeogenesis, which otherwise occurs due to catabolism of fats and proteins. Provides calories for some metabolic needs. Each 100mL provides 5 grams of Dextrose and each gram of Dextrose Monohydrate provides 3.4kCal. Depending on the presence of insulin, glucose enters cells and is broken down to pyruvate. With adequate oxygen, it enters the Kreb's cycle in the mitochondria and is converted into energy (A.T.P.), CO2 and H2O. The brain does not require insulin for glucose metabolism. Even large volumes of infusion of the solution do not easily cause sodium excess and hyperchloremic acidosis. It expands circulating blood volume by approximating the fluid and electrolyte composition of the blood along with providing energy. Provides the following electrolytes in each liter of fluid:
Sodium	130 mEq.
Chloride	108.7 mEq.
Potassium	4 mEq.
Calcium	2.7 mEq.
Bicarbonate(as Lactate)	28 mEq.
Lactate is metabolized by the liver and converted to bicarbonate. One mole of lactate is metabolized in the body to produce one mole of bicarbonate. Therefore its administration has the same effect as that of bicarbonate. The presence of lactate not only eliminates any chances of dilutional acidosis, but also aids in the correction of mild acidosis. The infusion of 5% Dextrose and Ringer’s Lactate, does not induce hypokalemia and hypocalcemia as compared to normal saline. The pH range is 3.5 - 6.5.

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Pharmacological Effects

The usual infusion rate is 300-500 ml/hour (about 75-125 drops/minute) for adults and 50-100ml/hour (about 12-25 drops/minute) for children.
The dosage should be adjusted according to the age, weight and clinical condition of the patient. However, for non-diabetics, the maximum infusion rate of dextrose should be 4mg/kg/minute. At this rate the hepatic glucose production is minimized and peripheral glucose uptake maximized.

RINGOLACT-D

(Lactated Ringer’s and 5% Dextrose Injection U.S.P)

Therapeutic Class

Isotonic crystalloid solution and carbohydrate source.

Description and Composition

a:2:{s:7:"English";s:617:"

A clear, colorless solution, each 1000 ml. of which contains:
Calcium Chloride 2H2O	0.2 grams
Potassium Chloride	0.3 grams
Sodium Chloride	6.0 grams
Sodium Lactate	3.1 grams
Dextrose Monohydrate	50.0 grams
Water for Injections q.s.

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Indications

a:2:{s:7:"English";s:511:"

Hypovolemic states such as those induced by severe diarrhea and vomiting.

Trauma and burns.

Environmental emergencies such as severe perspiration leading to dehydration and heat illness.

Also indicated for the prevention and replenishment of extracellular fluid before, during and after surgery.

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Pharmacological Effects

a:2:{s:7:"English";s:2402:"

5% Dextrose and Lactated Ringer’s Injection has an electrolyte composition and concentration similar to that of the extracellular fluid along with added dextrose which acts as a caloric source. In stressful situations, e.g. surgery, provision of dextrose prevents gluconeogenesis, which otherwise occurs due to catabolism of fats and proteins. Provides calories for some metabolic needs. Each 100mL provides 5 grams of Dextrose and each gram of Dextrose Monohydrate provides 3.4kCal. Depending on the presence of insulin, glucose enters cells and is broken down to pyruvate. With adequate oxygen, it enters the Kreb's cycle in the mitochondria and is converted into energy (A.T.P.), CO2 and H2O. The brain does not require insulin for glucose metabolism. Even large volumes of infusion of the solution do not easily cause sodium excess and hyperchloremic acidosis. It expands circulating blood volume by approximating the fluid and electrolyte composition of the blood along with providing energy. Provides the following electrolytes in each liter of fluid:
Sodium	130 mEq.
Chloride	108.7 mEq.
Potassium	4 mEq.
Calcium	2.7 mEq.
Bicarbonate(as Lactate)	28 mEq.
Lactate is metabolized by the liver and converted to bicarbonate. One mole of lactate is metabolized in the body to produce one mole of bicarbonate. Therefore its administration has the same effect as that of bicarbonate. The presence of lactate not only eliminates any chances of dilutional acidosis, but also aids in the correction of mild acidosis. The infusion of 5% Dextrose and Ringer’s Lactate, does not induce hypokalemia and hypocalcemia as compared to normal saline. The pH range is 3.5 - 6.5.

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Pharmacological Effects