Lactated Ringer's solution is contraindicated in:

Appeared in: AIIMS Nagpur NO- 2020

Explanation

Lactated Ringer's (LR) solution contains lactate, which is metabolized by the liver into bicarbonate, a base.
In lactic acidosis, the body has an excess of lactate, and the metabolic capacity to process it is already overwhelmed.
Administering more lactate via LR can worsen the acidosis because the impaired liver cannot convert it to bicarbonate effectively.
Therefore, LR is contraindicated as it adds to the lactate load instead of helping to correct the acid-base imbalance.

Option B: This is a primary indication for LR. Its balanced electrolyte composition is ideal for replacing fluids lost through the GI tract.
Option C: This is a classic indication for LR. It is the fluid of choice for initial resuscitation in major burns to prevent hypovolemic shock.
Option D: This is a common indication for LR. As an isotonic crystalloid, it effectively expands intravascular volume in patients with hypovolemia from various causes.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Contraindications of Intravenous Fluids as background academic context rather than a clinical decision trigger.
A nurse must always verify a patient's diagnosis and recent lab values before administering IV fluids. In a patient with suspected sepsis or shock, checking the lactate level is critical before choosing between LR and Normal Saline.
Choosing the wrong IV fluid can have severe consequences. Giving LR to a patient in lactic acidosis can worsen their metabolic state and lead to poorer outcomes.
Patient safety depends on understanding not just the indications but also the contraindications of common treatments like IV fluid therapy.

How to Approach the Question

First, identify the core of the question: it asks for a contraindication for Lactated Ringer's (LR) solution.
Recall the unique component of LR: it contains lactate.
Consider the metabolic fate of lactate: the liver converts it to bicarbonate.
Now, evaluate each option based on this knowledge.
Option A (Lactic acidosis): If the body already has too much lactate, adding more would be illogical and potentially harmful, especially if liver function is compromised. This is a strong candidate for a contraindication.
Options B, C, and D (Fluid loss, Burns, Hypovolemia): These are all conditions requiring volume replacement. LR is a standard isotonic fluid used for this purpose. These are indications, not contraindications.

Concept Tested & Keywords

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Attempt every question from this paper in a timed mock, then review the full solution for each one.