In this episode, I’ll discuss how lactated ringers solution can play a role in managing a sodium bicarbonate shortage.
For patients not affected by septic shock or reduced perfusion, the lactate in lactated ringers will be converted to bicarbonate shortly after being infused.
Each liter of lactated ringers contains 28 mEq lactate. Here is how it works:
Lactate [CH3CH(OH)COO−] serves as the raw material for regeneration of bicarbonate (HCO3−). The liver metabolizes lactate to glycogen which is then converted to carbon dioxide and water by oxidative metabolism. This, in turn, generates bicarbonate.
Existing sodium ions combine with the bicarbonate ion, and it is retained, thus combating metabolic acidosis.
Because metabolic conversion of lactate to bicarbonate relies on normal cellular oxidative processes, lactated ringers is only an effective source of bicarbonate in patients suffering from acidosis without shock or other disorders involving reduced perfusion of body tissues.
The whole process of converting lactate to bicarbonate takes 1 or 2 hours under normal circumstances.
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So are we giving roughly 28meq bicarb with each liter of lactated ringers (after the one or two hour conversion time)? In other words, is the 28meq lactate roughly equivalent to 28meq of bicarb after it’s undergone conversion in the body? Thanks for all the work you do here Joe.
Hi Jeff, yes that is the conversion as I understand it. So glad you find the podcast helpful!