Heparin - General
💡 Key Tip: Hartmann’s (Ringer’s lactate) is often preferred over 0.9% saline to avoid
hyperchloraemic acidosis.
⚠️ Do not mix with citrated blood products (risk of clotting due to calcium content).
📖About
- 💧 Crystalloid solution developed by physiologist Sidney Ringer in 1882.
- Known in the UK as Hartmann’s solution (Ringer’s lactate internationally).
- 🌡️ Widely used in perioperative, trauma, burn, and septic patients for fluid resuscitation.
- Isotonic, glucose-free, and suitable for most surgical/critical care scenarios.
🧪Contents (approximate)
- 🧂 Sodium: 131 mmol/L
- 🧂 Chloride: 111 mmol/L
- 🍌 Potassium: 5 mmol/L
- 🦴 Calcium: 2 mmol/L
- 🌀 Lactate: 29 mmol/L (metabolised → bicarbonate in liver)
- ⚖️ pH: ~6.5
- 🔬 Osmolarity: ~273 mOsm/L
🎯 Indications
- 💉 Fluid resuscitation in sepsis, trauma, burns.
- 💊 Maintenance fluids when NBM (nil by mouth).
- 🫀 Intra-operative and post-operative volume replacement.
- 🧪 Helps buffer mild metabolic acidosis (via lactate metabolism).
💊 Dose (General Guidance)
- 🔄 Resuscitation: 500 mL IV over 15–30 mins, reassess; repeat as required.
- 🧍 Maintenance: Typically 25–30 mL/kg/day (often combined with potassium supplements if required).
- 📌 Always follow local BNF or NICE protocol.
⚠️ Contraindications
- 🫁 Severe liver failure: lactate may not be metabolised → lactic acidosis risk.
- 🍌 Hyperkalaemia or 🦴 hypercalcaemia (contains K⁺ & Ca²⁺).
- 🫀 Heart failure / renal impairment: risk of fluid overload.
- ⬆️ Metabolic/respiratory alkalosis: may worsen alkalosis.
- 💉 Blood transfusion with citrated products (calcium can precipitate clotting).
💢 Side Effects
- 📈 Raised serum lactate (usually mild in normal liver function).
- 🌊 Fluid overload (esp. CKD or CHF patients).
- ⚡ Electrolyte changes (K⁺, Ca²⁺ shifts if high volumes given).
- 💉 Local phlebitis at infusion site (rare).
🔄 Interactions
- 🚫 Incompatible with: methylprednisolone, nitroglycerin, nitroprusside, norepinephrine (check compatibility charts).
- ⚠️ Blood products with citrate anticoagulant — risk of clotting due to calcium.
📚 References
