Resuscitation with lactated Ringer's solution after hemorrhage: lack of cardiac toxicity.
Level 5 - mechanism / opinion, no new human data
Animal laboratory study
What was done
Conscious, unrestrained male Sprague-Dawley rats (n = 24) underwent hemorrhage followed by resuscitation with L-lactated, D-lactated, or racemic lactated Ringer's solution while being monitored for electrocardiographic abnormalities and acid-base alterations.
What was found
Rats infused with pure D-lactate developed cardiac toxicity evidenced by bradycardia, premature ventricular contractions, and ventricular fibrillation. In contrast, no rhythm alterations occurred with L-lactate or racemic lactated Ringer's. Resuscitation with the racemic mixture increased blood D-lactate concentrations but produced no overt changes in cardiac rhythm, with few significant differences in acid-base status among groups. The abstract provides no specific numerical values.
Why it matters
These findings suggest that standard racemic lactated Ringer's solution does not generate circulating D-lactate concentrations high enough to cause cardiotoxicity during hemorrhage resuscitation.
Limits
The study was conducted in a small rodent model (n = 24 total), precluding direct translation to human trauma resuscitation. The abstract reports no numerical values, variance, or specific statistical test results for the physiological and biochemical measurements.
Cited by
- supports Lactated Ringer's solution was historically prepared as a 50/50 racemic mixture of D-lactate and L-lactate.