Spreading the Word: In Hyperkalemia Ringer’s Lacate is Superior to Normal Saline

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Just recently the discussion came up once again on what sort of infusion should be used in patients with hyperkalemia. To my surprise the idea seems to persist that normal saline (NS) should be used, as this solute does not contain any further potassium. This is a thought in the wrong direction and Pulmcrit made a great statement in 2014 to clarify this myth. The key points are as follows:

Infusing Ringer’s lactate (RL) in a patient with hyperkalemia will actually lower his serum potassium level
Even a solute with twice the potassium concentration of RL (this would be 8mmol/L) would require a vast amount of fluid to create any effect in serum potassium levels
NS has been shown to produce non-anion gap metabolic acidosis, which causes potassium to shift out of cells, thereby increasing potassium levels
RL does not cause any acidosis

Here’s all the background reading including references:

Pulmcrit Myth-busting: RL is safe in hyperkalemia, and is superior to NS

This might also be of interest. Have a very close look on normal saline infusions:

Normal Saline and Acidosis: Is it Really the Salt that Matters?


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