Ringer lactate is contraindicated in?

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2019

Explanation

Ringer's Lactate (RL) contains lactate, which the body's liver normally converts into bicarbonate to buffer acid.
In lactic acidosis, the body already has an excess of lactate, and liver function is often impaired, reducing its ability to process more.
Administering RL to a patient with lactic acidosis can worsen the condition by adding to the lactate load that the body cannot clear.
This makes monitoring the patient's own lactate production difficult and can lead to a more severe metabolic acidosis.

Option A: This is incorrect. Ringer's Lactate is indicated for treating fluid loss from diarrhoea.
Option C: This is incorrect. Ringer's Lactate is a first-line fluid for resuscitation in burn patients.
Option D: This is incorrect. Ringer's Lactate is a standard treatment for hypovolemia.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Contraindications of Ringer's Lactate solution as background academic context rather than a clinical decision trigger.
Nurses must always assess the patient's underlying condition and review lab results (e.g., lactate levels, liver function tests) before administering Ringer's Lactate.
Administering RL to a patient with impaired lactate metabolism can worsen their metabolic acidosis and lead to clinical deterioration. Close monitoring is essential.
It is also crucial to remember that RL contains calcium and should not be administered through the same IV line as blood products, as it can cause clotting.

How to Approach the Question

First, identify the core of the question, which asks for a contraindication for Ringer's Lactate (RL).
Recall the key component of RL that differentiates it from Normal Saline: lactate.
Think about how the body processes lactate. The liver metabolizes it into bicarbonate.
Evaluate each option based on this metabolic pathway:
Diarrhoea, Burns, and Hypovolemia are all conditions involving fluid and electrolyte loss, where volume expansion and a bicarbonate precursor would be beneficial.
Lactic acidosis is a state where the body is already failing to clear lactate. Adding more lactate from an IV fluid would logically be harmful.

Concept Tested & Keywords

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