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Abstract: PO1459

Effect of Lactated Ringer Solution Use on Serum Potassium in Advanced Kidney Disease

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

  • 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical


  • Rajasekaran, Arun, UAB, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Bade, Naveen K., UAB, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Zarjou, Abolfazl, UAB, The University of Alabama at Birmingham, Birmingham, Alabama, United States

Lactated Ringer’s (LR) solution is a balanced crystalloid containing 4 mEq/L of potassium (K). Its use is restricted in hyperkalemia and in those with advanced kidney disease given potential concerns of exacerbating hyperkalemia. We assessed the effect of LR on serum K levels in patients with advanced kidney disease.


Retrospective evaluation of 191 patient encounters with advanced kidney disease [defined by estimated glomerular filtration rate (eGFR) of < 30 ml/min/1.73m2 - including patients with acute kidney injury (AKI), chronic kidney disease (CKD), AKI on CKD, and end-stage kidney disease (ESKD) either on dialysis or post renal-transplantation] admitted at the University of Alabama at Birmingham Hospital between 9/1/2017 to 9/1/2018 who received LR for resuscitation and its effect on serum K levels. We stratified patients based on renal function; accounted for concomitant medication use that frequently potentiate hyperkalemia, use of K supplements, blood transfusions immediately prior to LR use, presence of sepsis, and administration of tube feeds.


Average age of patients was 59 years. 19 patients had AKI, 60 patients had AKI on CKD, 20 patients had known CKD, and 61 had ESKD (including 11 who had renal transplantation). Average LR use was 1.9L per patient. Hyperkalemia [defined by serum K ≥ 5.2 mEq/L] was seen in 27 patient encounters (14.1% of the study population). However, 16 of these patients had average K of 5.8 mEq/L prior to LR use. 11 among them were managed with medications alone and 4 patients needed dialysis. Average and highest K levels among all patients within 24-hour post LR use were 4.2 mEq/L and 4.4 mEq/L respectively. 131 patient encounters had sepsis. There was 1 death attributable to hyperkalemia.


27 out of 191 patient encounters (14.1%) with advanced kidney disease in our cohort had hyperkalemia within 24 hours post-LR administration, and 16 had known hyperkalemia prior to LR use. Our study demonstrates that LR use is not independently associated with hyperkalemia in advanced kidney disease, a population subset who frequently cannot renally excrete K adequately. Further large scale clinical studies are warranted to confirm our findings.