Pharmaceutical name: Sodium Lactate Ringer's Injection
Alias: Sodium Lactate Ringer's Injection
Physical and chemical properties: 1000ml contains the following ingredients:
Sodium chloride 6.0g Calcium chloride 0.2g
Potassium chloride 0.3g Sodium lactate 3.1g
Properties: This product is a colorless and clear liquid.
Pharmacological effects:
The electrolyte composition of this product is similar to that of extracellular fluid, and it can replenish electrolytes and water with certainty. When surgical invasion or shock occurs, the amount of circulating blood is lost due to bleeding, and a large amount of extracellular fluid is lost. For such a large loss of body fluids, it is most appropriate to use this product with electrolytes similar to those of plasma and extracellular fluid, and the prognosis is also Good. In addition, the sodium lactate contained in this product becomes HCO3- after metabolism in the body and can adjust acidosis.
Toxicity:
Acute toxicity LD50
Rabbit (intravenous drip 100ml/kg/h)>600ml/kg
Effect And uses:
Medicines for regulating body fluids, electrolytes, and acid-base balance, and used to prevent acidosis, blood loss, bleeding during surgery, dehydration, and electrolyte disorders.
Usage and dosage:
Intravenous infusion of 500-1000ml once for ordinary adults
Dosing speed: 300-500ml per hour for ordinary adults.
It can be increased or decreased appropriately according to age, weight and symptoms.
Storage: airtightly stored
Validity period: five years
Adverse reactions and precautions:
Attention:
The following patients are contraindicated:
1. Patients with lactic acidemia
The following patients should be used with caution:
1. Patients with renal insufficiency due to renal disease
2. Patients with cardiac insufficiency
3. Patients with severe liver disorders
4. Patients with hyperosmolar dehydration
5. Patients with obstructive urinary disease Patients suffering from road diseases and reduced urine output
Side effects:
When administered in large amounts rapidly, cerebral edema, pulmonary edema, and peripheral edema may occur.
Note on compatibility:
1. This product contains calcium salt, which will cause coagulation when mixed with citric acid and blood, so caution should be used when using it.
2. Mixing with phosphate ions and carbonate ions can cause precipitation. Do not use it in conjunction with such preparations.
Drug name Glucose and Sodium Chloride Injection
English name GlucoseandSodiumChlorideInjection
Drug alias
This product is a compound preparation, containing 5 % glucose and 0.9% sodium chloride.
Properties
This product is a colorless, clear liquid.
Pharmacology and Toxicology
Glucose is one of the main sources of calories for the human body. Sodium and chlorine are important electrolytes in the body. They mainly exist in extracellular fluid and play a very important role in maintaining the normal volume and osmotic pressure of blood and extracellular fluid in the human body.
Pharmacokinetics
After glucose enters the human body, the normal human body has a utilization capacity of 6mg/kg per minute.
Indications
Replenish heat energy and body fluids. It is used for insufficient eating or loss of large amounts of body fluids caused by various reasons.
Usage and dosage
The usage and dosage of glucose and sodium chloride should be considered at the same time:
1. Usage and dosage of glucose:
1. When patients who supplement heat energy eat less or cannot eat due to some reasons, they can generally give 10% to 25% glucose injection intravenously and replenish body fluids at the same time. The amount of glucose used is calculated based on the required heat energy.
2. Glucose is the most important energy supply substance for total intravenous nutrition therapy. Among non-protein heat energy, the ratio of glucose and fat energy supply is 2:1. The specific dosage is determined based on clinical caloric requirements.
According to the needs of fluid replenishment, glucose can be mixed into different concentrations of 25% to 50%, and insulin is added when necessary. 1 unit of regular insulin is added for every 5 to 10g of glucose. Since this product is often used in hypertonic solutions, which are highly irritating to veins and require the infusion of fat emulsion, deeper large veins, such as the subclavian vein, internal jugular vein, etc., are generally used.
3. In severe cases of hypoglycemia, 20 to 40 ml of 50% glucose injection can be administered intravenously first.
4. For severe cases of starvation ketosis, intravenous infusion of 5 to 25% glucose injection should be used. 100g of glucose per day can basically control the condition.
5. Water loss: For isotonic water loss, intravenous infusion of 5% glucose injection is given.
6. Hyperkalemia should be treated with 10-25% injection, adding 1 unit of regular insulin for every 2-4g of glucose, which can reduce serum potassium concentration. However, this therapy only allows extracellular potassium ions to enter the cells, leaving the total potassium content in the body unchanged. If potassium depletion measures are not taken, hyperkalemia may still occur again.
7. Tissue dehydration hypertonic solution (usually 50% glucose injection) is quickly intravenously injected with 20 to 50 ml. But the effect is short-lived. Clinically, attention should be paid to preventing hyperglycemia and it is used sparingly at present. When used to adjust the osmotic pressure of peritoneal dialysate, 20ml of 50% glucose injection, or 10g of glucose, can increase the osmotic pressure of 1L of peritoneal dialysate by 55mOsm/kgH2O. That is, for every 1% increase in glucose concentration in the dialysate, the osmotic pressure increases by 55mOsm/kgH2O.
2. Usage and dosage of sodium chloride:
1. Hypertonic dehydration: In patients with hypertonic dehydration, the osmotic concentration of brain cells and cerebrospinal fluid increases. If treatment causes the sodium concentration and osmotic concentration of plasma and extracellular fluid to decrease too quickly, cerebral edema may occur. Therefore, it is generally believed that within the first 48 hours of treatment, the plasma sodium concentration will not decrease by more than 0.5mmol/L per hour.
If the patient is in shock, sodium chloride injection should be given first, and colloids should be supplemented as appropriate. After the shock is corrected, serum sodium >155mmol/L, plasma osmotic concentration >350mOsm/L, 0.6% hypoglycemic injection can be given Sodium chloride injection. When the plasma osmotic concentration is <330mOsm/L, use 0.9% sodium chloride injection instead. The total amount of fluid replacement is calculated according to the following formula, as a reference: [Serum sodium concentration (mmol/L)-142]
Required fluid replacement volume (L)=—————————————— × 0.6 Functions may be adjusted as appropriate.
2. The principle of isotonic dehydration is to give isotonic solutions, such as 0.9% sodium chloride injection or compound sodium chloride injection. However, the chlorine concentration of the above solutions is significantly higher than that of plasma. Use alone in large amounts can cause hyperchloremia, so it can be 0.9% sodium chloride injection and 1.25% sodium bicarbonate or 1.86% (1/6M) sodium lactate are prepared in a ratio of 7:3 and then supplied. The latter has a chlorine concentration of 107mmol/L and can correct metabolic acidosis. The amount of supplement can be calculated based on body weight or hematocrit as a reference.
① Calculated based on body weight: Fluid replacement volume (L) = (Weight loss (kg) × 142)/154;
② Calculated based on hematocrit: Fluid replacement volume (L) = (Actual hematocrit - normal hematocrit × weight (kg) × 0.2)/normal hematocrit. Normal hematocrit is 48% for men and 42% for women.
3. Hypotonic water loss: During severe hypotonic water loss, solutes in brain cells decrease to maintain cell volume. If treatment causes the sodium concentration and osmotic concentration in plasma and extracellular fluid to rise rapidly, it may cause damage to brain cells. It is generally believed that when blood sodium is lower than 120mmol/L, treatment can increase blood sodium at a rate of 0.5mmol/L per hour and no more than 1.5mmol/L per hour. When the blood sodium is lower than 120mmol/L or central nervous system symptoms occur, 3% to 5% sodium chloride injection can be given by slow infusion. It is generally required to increase the blood sodium concentration to above 120mmol/L within 6 hours. Amount of sodium supplement (mmol/L) = [142 - actual blood sodium concentration (mmol/L)] × body weight (kg) × 0.2.
When the blood sodium rises to above 120-125mmol/L, an isotonic solution can be used instead or a hypertonic glucose injection or 10% sodium chloride injection can be added to the isotonic solution as appropriate.
4. For hypochloric alkalosis, give 0.9% sodium chloride injection or compound sodium chloride injection (Ringer's solution) 500 to 1000 ml. The dosage will be determined based on the alkalosis.
Adverse reactions
1. Too much or too fast infusion can cause water and sodium retention, causing edema, increased blood pressure, accelerated heart rate, chest tightness, difficulty breathing, and even acute left heart failure.
2. Inappropriate administration of hypertonic sodium chloride can cause hypernatremia.
3. Too much or too fast administration of hypotonic sodium chloride can cause hemolysis, cerebral edema, etc.
4. Phlebitis: occurs during infusion of hypertonic glucose injection. Switching to large intravenous drip, the incidence of phlebitis decreased.
5. Extravasation of high-concentration solution injections may cause local swelling and pain.
6. Reactive hypoglycemia: It is easy to occur when excessive use of insulin is combined with the original tendency of hypoglycemia and sudden cessation of total intravenous nutrition therapy.
7. Hyperglycemic nonketotic coma: It is more common in patients with diabetes, stress, the use of large doses of glucocorticoids, and uremic peritoneal dialysis who are given intraperitoneal hypertonic glucose solutions and total intravenous nutrition therapy.
8. Electrolyte imbalance: Low potassium, hyponatremia and hypophosphatemia are likely to occur when simply supplementing glucose for a long time.
Contraindications
(1) People with brain, kidney, and heart dysfunction;
(2) People with low plasma protein;
(3) Patients with uncontrolled diabetes and ketoacidosis;
(4) Patients with hyperosmolar dehydration;
(5) Hyperglycemia and hyperosmolar state.
Precautions
(1) Use with caution in the following situations: ① Edema diseases, such as nephrotic syndrome, cirrhosis, ascites, congestive heart failure, acute left heart failure, cerebral Edema and idiopathic edema, etc.; ② The oliguric stage of acute renal failure, chronic renal failure with reduced urine output and poor response to diuretics; ③ Hypertension; ④ Hypokalemia; ⑤ The amount and speed of fluid replacement in the elderly and children Should be strictly controlled.
(2) Follow-up examination: ① Serum sodium, potassium, and chloride concentrations; ② Blood acid-base balance indicators; ③ Renal function; ④ Blood pressure and cardiopulmonary function.
(3) Injecting too much glucose during delivery can stimulate fetal insulin secretion and cause postpartum infant hypoglycemia.
(4) Use with caution in the following situations: ① Patients with periodic paralysis and hypokalemia; ② Hyperglycemia is easily induced under stress or when using glucocorticoids; ③ Edema and severe cardiac and renal insufficiency , People with liver cirrhosis and ascites are prone to water retention, and the infusion volume should be controlled; especially those with cardiac insufficiency, the drip rate should be controlled.
Medication for pregnant and lactating women
No special precautions.
Medication for children
The amount and speed of fluid replacement should be strictly controlled.
Medication for elderly patients
The amount and speed of fluid replacement should be strictly controlled.
Overdose
Can cause hypernatremia and hypokalemia, and can cause bicarbonate loss.
Specifications
(1) 100ml: 5g glucose and 0.9g sodium chloride
(2) 100ml: 10g glucose and 0.9g sodium chloride
p>(3) 250ml: 12.5g glucose and 2.25g sodium chloride
(4) 250ml: 25g glucose and 2.25g sodium chloride
(5) 500ml : 25g glucose and 4.5g sodium chloride
(6) 500ml: 50g glucose and 4.5g sodium chloride
(7) 1000ml: 50g glucose and 9g sodium chloride
p>Storage
Keep airtight.