A Comparison of Normal Saline and Lactated Ringer's Iv Solution in the Treatment of Shock

In most cases of shock reducing morbidity and mortality depends on adequate, appropriate, and timely fluid resuscitation. To develop an effective resuscitation plan the Acute Care Nurse Practitioner (ACNP) must consider several important factors. Currently a wide variety of literature exists on the treatment of patients in need of fluid resuscitation due to shock; however there is limited agreement on a fluid or combination of fluids that provide the most benefit. The purpose of this project is to review the resuscitation literature related to the use of normal saline and lactated Ringer’s for shock resuscitation. The review examines the literature concerning the effect of these fluids on metabolic pH, coagulation factors, the inflammatory cascade, and cellular apoptosis. Data show that large volumes of normal saline does cause a metabolic acidosis and dilutes circulating clotting factors, however this appears to be transitory. Lactated Ringer’s does not cause a metabolic acidosis, but more fluid is required for resuscitation from massive hemorrhage and it increases the rate of cellular apoptosis. Both fluids cause an increase in adhesion properties (CD18), an indication of inflammatory response. Currently there is no ideal resuscitation fluid and consideration should be given to including both fluids for large volume resuscitation. A combination mitigates the potential consequences that occur with one fluid alone. It is important for the ACNP utilize the current literature to design a resuscitation strategy that meets the needs of the patient but minimizes the long term complications.