Abstract
Background
Emerging evidence supports the superiority of balanced crystalloids such as Lactated
Ringer's (LR) compared to normal saline but concerns for the development of hyperkalemia
have limited its use. Although LR inherently contains potassium, there exists a paucity
of evidence to suggest that LR could potentiate hyperkalemia. To address this, we
evaluated the effect of LR on serum potassium in patients with reduced kidney function
who are at risk of developing hyperkalemia.
Methods
We conducted a single-center, retrospective cohort-based observational clinical study
that included 293 clinical encounters who were hospitalized with an estimated glomerular
filtration rate (eGFR) of < 30 ml/min/1.73m2, at the time of hospital admission. Subjects must have received a minimum of 500
ml of LR continuously during the admission. Only those with a minimum of one lab report
within 24 hours prior to-, and post-LR administration that reported serum measurements
of potassium, glucose, and bicarbonate levels were included. Other potential risk
factors for developing hyperkalemia including medication, tube feeds, potassium supplements,
and red blood cell transfusion during or within 24 hours after LR administration were
recorded.
Results
Serum potassium prior to LR use was highly correlated and predictive of the serum
potassium after LR use [P < 0.0001; Odds Ratio 6.77 (3.73 – 12.28)]. Sixteen encounters
(5%) developed de-novo hyperkalemia following LR use. No significant positive correlation between the amount
of LR administered and the development of hyperkalemia was found.
Conclusions
LR use was not independently associated with the development of hyperkalemia in patients
with reduced kidney function.
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Article info
Publication history
Published online: April 28, 2022
Accepted:
April 22,
2022
Received:
August 4,
2021
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
