Y ringer lactate is not preffered in met alkalosis
Reading File
Finding Sources
Searching PubMed
metabolic alkalosis AND fluids
Searching the Web
Ringer lactate metabolic alkalosis chloride treatment normal saline
Ringer lactate (RL) is generally not preferred for chloride-responsive metabolic alkalosis, especially from vomiting or nasogastric suction, because:
- It contains lactate (28 mmol/L). The liver metabolizes lactate mainly to bicarbonate, which can add alkali and may sustain the alkalosis.
- Its chloride content is relatively low (109 mmol/L) compared with 0.9% saline (154 mmol/L). In volume-depleted metabolic alkalosis, chloride depletion prevents the kidney from excreting excess bicarbonate. Giving chloride is part of the treatment.
- It has less sodium than normal saline (130 vs 154 mmol/L), so it is less effective for restoring extracellular volume in this setting.
Therefore, the usual fluid is 0.9% normal saline plus potassium chloride as needed, provided the patient is volume depleted and has no contraindication. Restoring volume and chloride lets the kidney excrete bicarbonate and corrects the alkalosis.
Small nuance: RL is not universally forbidden. It can be reasonable for resuscitation when other priorities dominate, but it is not the targeted replacement fluid for chloride-depletion metabolic alkalosis. StatPearls notes that normal saline is suitable for gastric losses, whereas RL is more suited to replacing alkaline biliary or pancreatic losses.
This is a shared conversation. Sign in to Orris to start your own chat.