Scenario: 52 year old male after emergent exploratory laparotomy is admitted to ICU. Patient has Lactated Ringer's solution going at 125 cc/hr. 2 units of pRBC were ordered. Why it is a bad idea to mix Lactated Ringer's solution and pRBC through same IV line?
Answer: Lactated Ringer's solution contains calcium which may bind to the citrate (use as anticoagulant) in blood products. This promotes clot formation in donor blood (bag).
Normal Saline contains (per litre)
- 154 mEq/L of Na+ and
- 154 mEq/L of Cl−
Lactate Ringer contains (per litre)
- 130 mEq/L of Na+ (but total cations of 137 mEq/L , so still is isotonic)
- 109 mEq/L of Cl−
- 28 mEq/L of lactate
- 4 mEq/L of potassium
- 3 mEq/L of calcium
Lactate converts to bicarbonate in liver. Patients with lactic acidosis usually have inadequate liver metabolism of lactate so conversion to HCO3- from the infused lactate of LR is impaired and may give false readings of serial lactate measurements.
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