乳酸アシドーシスの患者さんに乳酸リンゲル液を投与して良いのか? [医学関連]


 Ringer’s lactate is often avoided in septic patients secondary to the fear of worsening lactic acidosis. This is also untrue, as the content of Ringer’s lactate is sodium lactate, not lactic acid. Administration of Ringer’s lactate will cause an excess of lactate, which will be utilized by the body for energy. However, in today’s practicing culture, there tends to be an emphasis on blood lactate levels.[3] This emphasis can lead to confusion in the interpretation of lactic acid levels. The adverse effect of worsening a lactic acid is not seen with Ringer’s lactate.


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高カリウム血症のある人に乳酸リンゲルは避けるべきか? [救急救命士について理解を!]






 There is a fear of Ringer’s lactate causing hyperkalemia and worsening lactic acidosis. To put it in perspective, Ringer’s lactate does include a concentration of potassium 4 mEq/L. Logically, if giving a patient who is hyperkalemic additional potassium would worsen hyperkalemia; however, this is not correct. A patient's potassium volume of distribution is larger than the extracellular compartment and equilibrates between the intracellular and extracellular compartments. Therefore, giving a patient, even a patient in renal failure, 4 mEq/L of potassium is not an additive effect.[5] In fact, giving Ringer’s lactate to a patient with hyperkalemia will trend the patient’s potassium level to 4 mEq/L.[6][7] Furthermore, patients' hyperkalemia may worsen with metabolic acidosis. Consequently, large-volume IV administration of normal saline may give patients a hyperchloremic non-anion gap metabolic acidosis. Ringer’s lactate does not have this effect.


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