Sodium Lactate Ringer's Injection

Indications:
Lactated Ringer's Injection is indicated as a source of water and electrolytes or as an alkalinizing agent.
Side effects:
Allergic reactions or anaphylactoid symptoms such as localized or generalized urticaria and pruritis; periorbital, facial, and/or laryngeal edema; coughing, sneezing, and/or difficulty with breathing have been reported during administration of Lactated Ringer's Injection. The reporting frequency of these signs and symptoms is higher in women during pregnancy.
Reactions which may occur because of the solution or the technique of administration include febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of infection, extravasation, and hypervolemia.
If an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures, and save the remainder of the fluid for examination if deemed necessary.
Precautions:
General
Do not connect flexible plastic containers of intravenous solutions in series, i.e., do not piggyback connections. Such use could result in air embolism due to residual air being drawn from one container before administration of the fluid from a secondary container is completed.
Pressurizing intravenous solutions contained in flexible plastic containers to increase flow rates can result in air embolism if the residual air in the container is not fully evacuated prior to administration.
Use of a vented intravenous administration set with the vent in the open position could result in air embolism. Vented intravenous administration sets with the vent in the open position should not be used with flexible plastic containers.
Lactated Ringer's Injections, USP must be used with caution. Excess administration may result in metabolic alkalosis.
Pregnancy: Teratogenic Effects
Pregnancy Category C. Animal reproduction studies have not been conducted with Lactated Ringer's Injection. It is also not known whether Lactated Ringer's Injection  can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Lactated Ringer's Injection should be given to a pregnant woman only if clearly needed.
Nursing Mothers
It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Lactated Ringer's Injection is administered to a nursing woman.
Warnings:
Lactated Ringer's Injection should be used with great care, if at all, in patients with congestive heart failure, severe renal insufficiency, and in clinical states in which there exists edema with sodium retention.
Lactated Ringer's Injection should be used with great care, if at all, in patients with hyperkalemia, severe renal failure, and in conditions in which potassium retention is present.
Lactated Ringer's Injection should be used with great care in patients with metabolic or respiratory alkalosis. The administration of lactate ions should be done with great care in those conditions in which there is an increased level or an impaired utilization of these ions, such as severe hepatic insufficiency.
Lactated Ringer's Injection should not be administered simultaneously with blood through the same administration set because of the likelihood of coagulation. The intravenous administration of Lactated Ringer's Injection can cause fluid and/or solute overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states, or pulmonary edema. The risk of dilutional states is inversely proportional to the electrolyte concentration of the injections. The risk of solute overload causing congested states with peripheral and pulmonary edema is directly proportional to the electrolyte concentrations of the injections.
In patients with diminished renal function, administration of Lactated Ringer's Injection may result in sodium or potassium retention. Lactated Ringer's injection is not for use in the treatment of lactic acidosis.
Storage:
Store below 25ºC. Protect from light. KEEP OUT OF REACH OF CHILDREN.