0.9% NS should be used cautiously
in patients with congestive
heart failure (CHF) and those who
are hypertensive and have left ventricular
dysfunction because of the risk of
fluid overload.Causes of isotonic fluid
volume overload include excessive
administration of fluids and excessive
irrigation of body cavities (enemas,
peritoneal dialysis, gastric lavage, etc.).
LR should be used with caution in
patients who may be at risk for acidosis
such as diabetic ketoacidosis
(DKA) and chronic obstructive pulmonary
disease (COPD) patients. LR
should be avoided in hyperthermic
and febrile patients because the
breakdown of lactate found in LR is
lactic acid, which compounds the acidosis
due to body temperature elevation.The
liver is unable to metabolize
lactate when the body temperature is
elevated as in heat exhaustion, heat
stroke, and high fevers. Diabetic
patients receiving Metformin® (glucophage)
should not be given LR due
to Metformin’s common side effect of
metabolic acidosis, which would
potentiate a lactate complication
from an LR infusion (Criss, 2007). LR
can worsen cerebral edema, so it is
not the fluid of choice in a patient
with head trauma (Criss, 2007;
Thompson, 2005).
0.9% NS should be used cautiouslyin patients with congestiveheart failure (CHF) and those whoare hypertensive and have left ventriculardysfunction because of the risk offluid overload.Causes of isotonic fluidvolume overload include excessiveadministration of fluids and excessiveirrigation of body cavities (enemas,peritoneal dialysis, gastric lavage, etc.).LR should be used with caution inpatients who may be at risk for acidosissuch as diabetic ketoacidosis(DKA) and chronic obstructive pulmonarydisease (COPD) patients. LRshould be avoided in hyperthermicand febrile patients because thebreakdown of lactate found in LR islactic acid, which compounds the acidosisdue to body temperature elevation.Theliver is unable to metabolizelactate when the body temperature iselevated as in heat exhaustion, heatstroke, and high fevers. Diabeticpatients receiving Metformin® (glucophage)should not be given LR dueto Metformin’s common side effect ofmetabolic acidosis, which wouldpotentiate a lactate complicationfrom an LR infusion (Criss, 2007). LRcan worsen cerebral edema, so it isnot the fluid of choice in a patientwith head trauma (Criss, 2007;Thompson, 2005).
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