IV solutions

[Bullets]

Around these parts all medics carry at least one 500ml bag of NS and 1L bag in their kits and it is the go to solution (ba dum dum) for patients who are hypotensive or otherwise "needing" fluids

They are allowed to use LR but usually only carry it in their trucks and have to go get it if they need it. I know they are seen as interchangeable but is there a reason why NS is the default, as opposed to something like Ringers/Hartmans or even a MVI bag? Wouldnt the patients benefit from the added thiamine, folic acid, multivitamins, lactate and all the other fun-ness that comes with these "fortified" solutions?

 

[Anjel]

IV soultions

I know that normal saline is compatible with everything. You don't have to worry about what you are mixing in it.

And I believe it's cheaper.

For your typical every day pt that is getting an IV on the way to the hospital, NS works just fine and is isotonic.

 

[Carlos Danger]

I know they are seen as interchangeable

They aren't really interchangeable. A healthy patient can safely take large volumes of either, but there are conditions that would contraindicate one or the other, or at least make one less desirable than the other.

is there a reason why NS is the default

NS is cheap. And unlike LR, it is compatible with pretty much any drug or additive.

Most EMS agencies don't even carry LR. I'm not really sure why any would, considering the cost difference.

The last place I flew we carried 2 liters of LR because we transported a lot of burn patients. But even for us, I don't know if we ever reached a point in transport where we'd given so much NS that switching to LR conferred any benefit.

Wouldnt the patients benefit from the added thiamine, folic acid, multivitamins, lactate and all the other fun-ness that comes with these "fortified" solutions?

No, the patients wouldn't necessarily benefit. The only things in LR that aren't in NS is lactate and small amounts of calcium and potassium.

As for an MVI bag, I've never heard of those being used by EMS. There's no indication for that in the prehospital setting.

 

[Akulahawk]

Most likely it has to do with compatibility. NS is compatible with pretty much everything in the ambulance drug cabinet, with the possible exception of glucagon... and even then after reconstitution, it's probably compatible with NS in the line. NS is probably also a little cheaper.

 

[Shishkabob]

Plus you tend to mess with less electrolytes with NS than you do LR.


It's not just EMS that prefers NS, but most of medicine for most applications. I had LR at my last agency, rarely used it (though the medical director there liked LR in one IV and NS in the other for major traumas)

 

[Bullets]

When I have dealt with patients who are dehydrated they have gotten NS with a thiamine kicker . I guess the question is what's in the best interest of the patient. Is there another solution that has a benefit over NS?

 

[jwk]

It's not just EMS that prefers NS, but most of medicine for most applications. I had LR at my last agency, rarely used it (though the medical director there liked LR in one IV and NS in the other for major traumas)

Not sure where you get that unless you're talking about ER use. LR is used extensively in most OR's and other areas within the hospital. We use NS when administering packed RBC's, although it's not really necessary - LR works fine.

I'm not sure how much difference there is in cost - with our vendors, it's the same, and the hospital charges the same amount for liter of saline as it does for a liter of ringers (an absurd charge to be sure!).

 

[limpfurball]

The PH of the two is also different. LR is 6.6 while NS is 5. Not a huge difference but when giving large amounts of fluids it may make a difference.