Drugs List

Therapeutic Indications

Uses

Electrolyte imbalance (sodium and fluid depletion)
Fluid replacement

Administration

For intravenous infusion.

The infusion rate is usually 40 ml/kg/24 hours in adults and children older than 11 years.

The average paediatric infusion rate is 5 ml/kg/hour but the value varies with age:
Children aged 2 to 11 years: 2 to 4 ml/kg/hour
Toddler: 4 to 6 ml/kg/hour
Infant: 6 to 8 ml/kg/hour

Infusion rate and total volume can be higher in surgery or in case of need.

Contraindications

Ascites
Oedema
Cardiac failure
Hypercalcaemia
Hyperchloraemia
Hyperkalaemia
Hypernatraemia
Hypervolaemia
Severe hypertension
Severe renal impairment

Precautions and Warnings

Cardiopulmonary disorder
Elderly
Hypervitaminosis D
Peripheral oedema
History of congestive cardiac failure
Hyperaldosteronism
Hypertension
Pre-eclampsia
Pulmonary disease
Pulmonary oedema
Renal impairment

Avoid rapid infusion rates
Use only if the solution is clear and colourless
Monitor serum electrolytes before and during treatment
Examine bases of lungs for crepitations
Monitor ECG prior to and during treatment in existing cardiac abnormalities
Monitor fluid balance
Monitor patients with cardiac disorders

Pregnancy and Lactation

Pregnancy

Sodium chloride compound infusion (Ringer's solution) can be given during pregnancy as long as fluid and electrolyte balance is controlled.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Sodium chloride compound infusion (Ringer's solution) can be given during breastfeeding as its use is not considered to constitute a hazard.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Acidosis
Cardiac failure
Electrolyte disturbances
Febrile reactions
Local infection at injection site
Local pain (injection site)
Oedema
Thrombophlebitis (injection site)
Venous irritation

Presentation

Intravenous infusion of sodium chloride compound (Ringer's solution)

Drugs List

Therapeutic Indications

Uses

Electrolyte imbalance (sodium and fluid depletion)
Fluid replacement

Dosage

The rate and volume of infusion depends on the requirements of the individual patient and the judgement of the physician. Dosage should be based on the age, weight and clinical condition of the patient.

Adults

Elderly

Children

Administration

For intravenous infusion.

The infusion rate is usually 40 ml/kg/24 hours in adults and children older than 11 years.

The average paediatric infusion rate is 5 ml/kg/hour but the value varies with age:
Children aged 2 to 11 years: 2 to 4 ml/kg/hour
Toddler: 4 to 6 ml/kg/hour
Infant: 6 to 8 ml/kg/hour

Infusion rate and total volume can be higher in surgery or in case of need.

Contraindications

Ascites
Oedema
Cardiac failure
Hypercalcaemia
Hyperchloraemia
Hyperkalaemia
Hypernatraemia
Hypervolaemia
Severe hypertension
Severe renal impairment

Precautions and Warnings

Cardiopulmonary disorder
Elderly
Hypervitaminosis D
Peripheral oedema
History of congestive cardiac failure
Hyperaldosteronism
Hypertension
Pre-eclampsia
Pulmonary disease
Pulmonary oedema
Renal impairment

Avoid rapid infusion rates
Use only if the solution is clear and colourless
Monitor serum electrolytes before and during treatment
Examine bases of lungs for crepitations
Monitor ECG prior to and during treatment in existing cardiac abnormalities
Monitor fluid balance
Monitor patients with cardiac disorders

Pregnancy and Lactation

Pregnancy

Sodium chloride compound infusion (Ringer's solution) can be given during pregnancy as long as fluid and electrolyte balance is controlled.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Sodium chloride compound infusion (Ringer's solution) can be given during breastfeeding as its use is not considered to constitute a hazard.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Acidosis
Cardiac failure
Electrolyte disturbances
Febrile reactions
Local infection at injection site
Local pain (injection site)
Oedema
Thrombophlebitis (injection site)
Venous irritation

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: September 2013

Reference Sources

British National Formulary, 65th Edition (March - September 2013) Pharmaceutical Press, London.

BNF for Children (2013-2014) Pharmaceutical Press, London.

Summary of Product Characteristics: Ringer's Solution for Infusion. Baxter Healthcare Ltd. Revised February 2013.

Summary of Product Characteristics: Ringers Solution for Injection BPC59, as Steriflex No.9 or freeflex. Fresenius Kabi Ltd. Revised August 2006.

Summary of Product Characteristics: Ringers solution. Fresenius Kabi Ltd. Revised September 2009.