Ringer - instructions for use, dose, side effects, contraindications

Active substanceSodium chloride solution is complex [Potassium chloride + Calcium chloride + Sodium chloride]Sodium chloride solution is complex [Potassium chloride + Calcium chloride + Sodium chloride]

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Dosage form: & nbspsolution for infusions

Composition:

1 liter of solution contains:

Active substances:

Sodium chloride -8.6 g

Potassium chloride -0.3 g

Calcium chloride hexahydrate (in terms of anhydrous) - 0.25 g

Excipient:

Water for injections -to 1 L

Ionic composition per 1 liter:

Sodium ion - 147.2 mmol;

Potassium ion - 4.0 mmol;

Calcium ion - 2.25 mmol;

Chloride ion - 155.7 mmol.

Theoretical osmolarity is 309 mOsm / l.

Description:

Transparent colorless liquid.

Pharmacotherapeutic group:Electrolyte balance is a remedy.

ATX: & nbsp

B.05.B.B Solutions affecting the water-electrolyte balance

B.05.B.B.01 Electrolytes

Pharmacodynamics:

Rehydrating agent, has a detoxification effect, stabilizes the water and electrolyte composition of the blood. When used as a means of replenishing the volume of circulating blood, because of the rapid exit from the bloodstream into the intercellular space, the effect persists only for 30-40 minutes (in connection with which the solution is only suitable for short-term replenishment of the circulating blood volume).

Sodium, the main cation of extracellular fluid, takes part in the control of water distribution, water balance, osmotic pressure of body fluids. Sodium is also associated with chlorine and bicarbonate in regulating the acid-base state of body fluids.

Potassium, the main cation of intracellular fluid, takes part in the metabolism of carbohydrates and the synthesis of proteins, is needed to regulate the conduction of nerve impulses and muscle contraction.

Calcium, in ionized form is needed for the functional mechanism of blood coagulation, normal heart function, regulation of neuromuscular excitability.

Chlorine, the main extracellular anion, is closely associated with the metabolism of sodium, plays a role in the regulation of the acid-base balance of the body.

Pharmacokinetics:

Pharmacokinetics of sodium ions (Na+) and chlorine (C1-), introduced with Ringer's solution, is the same as for those who enter with food. They are freely distributed in all organs, tissues and intercellular spaces and are secreted by glomerular filtration in the kidneys. In the tubules there is a substantial reabsorption of ions Na+ and CP, mainly in the Henle loop and distal tubules.

Potassium ions (K +) are freely filtered in the glomeruli, but almost completely reabsorbed in the proximal tubules, so that the excretion is only 10% of the filtered K + ions. Secretion in the distal tubules and collecting tubules can significantly increase the elimination of K +. Kidneys have a limited ability to retain K + concentration. Therefore, when the concentration Na+ in the distal tubules high, the loss of K + can be significant and hypokalemia may develop. This causes the presence of K + in Ringer's solution.

Homeostasis of calcium ions (Ca ++) is well controlled by hormones and rarely needs clinical intervention with intravenous solution infusion.

The drug does not undergo metabolic transformations in the body. Quickly excreted by the kidneys, within 4 hours 80% is output, and after 12-24 hours it is output completely. Information about the pharmacokinetics refers to the ions that make up the drug.

Indications:

Dehydration and disturbance of electrolyte balance (with thermal burns of severe 3 and 4 degrees, frostbite, prolonged vomiting and diarrhea), acute blood loss, correction of water-salt balance in acute diffuse peritonitis and intestinal obstruction, intestinal fistula, acute intestinal infection, hypovolemic shock, therapeutic plasmapheresis.

Used to dilute concentrated electrolyte solutions.

Contraindications:

Hypersensitivity to drug components, hypernatremia, hyperchloremia, acidosis, chronic heart failure (III-IV functional class for NYHA), oliguria, anuria, chronic renal failure, pulmonary edema, cerebral edema, hypercoagulation, hypervolemia, thrombophlebitis, metabolic alkalosis, concomitant glucocorticosteroid therapy.

Carefully:

Arterial hypertension, chronic heart failure (I-II functional class for NYHA), especially in the postoperative period or in elderly patients; patients receiving cardiac glycosides, while using with blood products. Chronic renal failure of mild and moderate degree. Violation of the function of the liver.

Pregnancy and lactation:

Studies of the possibility of using the drug during pregnancy and during breastfeeding were not conducted. In this regard, the drug should be used in pregnant women only in cases where the expected benefit to the mother exceeds the possible risk to the fetus. It should refrain from breastfeeding during the period of use of the drug because of the lack of relevant clinical data.

Dosing and Administration:

The volume of the injected fluid depends on the type of dehydration, the degree of dehydration and the body weight of the patient, the cause of the shock.

Intravenously drip, at a rate of 60-80 cap / min, with a severe course of the disease - 70-90 cap / min, or jet. The daily dose for adults - 5-20 ml / kg, if necessary, can be increased to 30-50 ml / kg. The daily dose for children is 5-10 ml / kg, the rate of administration is 30-60 cap / min, with shock dehydration initially injected with 20-30 ml / kg. The course of treatment is 3-5 days. The maximum volume of the injected solution is 3 liters / day.

In medical plasmapheresis, injected in a volume 2 times the volume of the removed plasma (1,2 - 2,4 l), in the case of pronounced hypovolemia - in combination with colloidal solutions.

For mild to moderate severity of acute intestinal infections, the drug is used only if oral rehydration is not possible.

With prolonged administration of large doses of the drug, it is desirable to monitor the electrolytes in plasma and urine.

Side effects:Hyperhydration, hyperkalemia, chloride acidosis, allergic reactions.

Overdose:

In case of an overdose, a disturbance in the balance of water and electrolytes (hypervolemia, hypernatremia, hypercalcemia, hyperchloremia) and acid-base state can occur. In case of an overdose, in most cases, it is enough to interrupt the administration of the drug. Symptomatic therapy is performed.

Interaction:

When combined with other drugs, it is necessary to visually check compatibility.

It is possible to increase the delay of sodium in the body with the simultaneous use of the following medicines: nonsteroidal anti-inflammatory drugs, androgens, anabolic hormones, estrogens, corticotropin, mineralocorticoids, vasodilators or ganglion blockers.

When used with potassium-sparing diuretics, angiotensin-converting enzyme (ACE) inhibitors and potassium preparations, the risk of hyperkalemia increases.

In combination with cardiac glycosides, the likelihood of their toxic effects increases.

Special instructions:

With prolonged parenteral therapy, it is necessary to determine laboratory parameters and provide a clinical assessment of the patient's condition for monitoring the concentration of electrolytes and the acid-base state every 6 hours (depending on the speed of infusion).

In the case of rapid introduction of a large volume of solution, it is necessary to control the acid-base state and the concentration of electrolytes. A change in the pH of the blood leads to a redistribution of potassium ions (a decrease in pH leads to an increase in serum levels of K +). The use of intravenous solutions can cause overloading with liquid and / or solution components, The dilution is inversely proportional to the concentration of electrolytes. The risk of development of overload solution - in the occurrence of stagnant phenomena with peripheral edema and pulmonary edema, is directly proportional to the concentration of electrolytes.

In connection with the content of sodium ions, the solution should be used with caution in patients with clinical conditions accompanied by sodium retention and edema. Solutions containing sodium should be used with caution in patients receiving corticosteroids or corticotropin.

The content of potassium requires caution when applying the solution to patients with heart disease, hyperkalemia, severe renal insufficiency, and clinical conditions accompanied by a retention of potassium in the body.

Due to the high level of chloride ions, long-term use of the drug is not recommended.

Calcium should be administered under ECG monitoring, especially in patients who receive digitalis (digitalis) preparations. Concentrations of calcium in the serum do not always reflect the concentration of calcium in the tissues.

In patients with reduced renal excretory function, the administration of the solution may delay sodium or potassium.

The presence of calcium ions requires caution in the case of simultaneous with special attention to patients receiving cardiac glycosides.

This solution is intended for intravenous use with sterile equipment.It is recommended to change the intravenous system at least every 24 hours. Use the solution only when it is clear and the bottle is sealed.

The physician should also consider the possibility of developing adverse reactions to drugs that are applied simultaneously with Ringer's solution.

If there is an adverse reaction, stop the infusion, assess the patient's condition and prescribe the necessary therapeutic measures. To reduce the risk of possible incompatibility arising from the mixing of this solution with other prescribed additives, the final infusion solution must be checked for the presence of turbidity or precipitation immediately after mixing, before use and periodically during application. If the container contents become cloudy, do not use it.

Freezing during transportation is allowed.

Effect on the ability to drive transp. cf. and fur:

Clinical studies to assess the effect of the drug on the ability to manage vehicles and mechanisms have not been conducted.

Form release / dosage:

Solution for infusion.

For 100, 200, 250, 400, 500 or 1000 ml in polypropylene bottles, sealed with welded polypropylene caps.One bottle together with instructions for use in a pack of cardboard.

For hospitals

From 1 to 40 vials of 100, 200, 250, 400, 500 or 1000 ml together with instructions for use in an amount equal to the number of vials in a corrugated box of cardboard.

Packaging:1-40 vials, polypropylene bottles with holder (1) -Carboxes
polypropylene bottles with holder (1) -package cardboard

Storage conditions:

At a temperature of no higher than 25 ° C.

Keep out of the reach of children.

Shelf life:

2 years.

Do not use after the expiration date!

Terms of leave from pharmacies:On prescription

Registration number:LP-002543

Date of registration:24.07.2014

The owner of the registration certificate:GROTEKS, LLC GROTEKS, LLC Russia

Manufacturer: & nbsp

GROTEKS, LLC Russia

Information update date: & nbsp24.02.2015

Illustrated instructions

Instructions

Ringer (Ringer)