Question special
Moderator

Dear all and Dr.Seifter,
I would like to hear your thoughts and experiences on the effects of Ringer's Lactate on Acid/Base disorders.

First, I did a quick search a while ago and I found "The lactate is metabolized into bicarbonate by the liver, which can help correct metabolic acidosis." Is this completely true? Since at the liver, lactate is converted to glucose via gluconeogenesis, also to CO2 and H2O by Krebs cycle. So, where is bicarbonate from?

Second, would Ringer's lactate really help acidosis? Can it cause hyperchloremic metabolic acidosis? anion gap MA (lactic acidosis)? Metabolic alkalosis?
-Studies by Waters JH et.al. 2001 and Omron EM et. al. 2010 found hyperchloremic metabolic acidosis from LRS
- From HUMAN PRESCRIPTION DRUG LABEL. DailyMed., "aggressive administration of sodium lactate may result in metabolic alkalosis."
-I also often get asked if lactated ringers worsens lactic acidosis?

Can we answer this by Strong Ion/Stewart Model or Traditional acid base approach?

What acid/base disorders that you have experienced in the real practice with LRS?