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Crystalloid IV fluid Pregnancy: §4.6: Ringer's Solution for infusion can be used safely during pregnancy and lactation as long as the electrolyte and fluid balance is controlled. When a medicinal product is added, the nature of the drug and its use during pregnancy and lactation have to be considered separately. It should be administered with special caution to pregnant women during labour, particularly as to serum sodium if administered in combination with oxytocin.

Potassium chloride with calcium chloride and sodium chloride

Brand names: Ringer's solution

Used in: Hyperkalaemia Hyponatraemia

This is a balanced intravenous crystalloid solution combining potassium chloride, calcium chloride dihydrate and sodium chloride (a Ringer's-type solution) used for fluid and electrolyte replacement.

Adult dose

Dose: Replacement of extracellular fluid losses and restoration of sodium, potassium, calcium and chloride balance in isotonic dehydration — adults, the elderly and adolescents: 500 ml to 3 litres per 24 hours by intravenous infusion
Route: Intravenous infusion
Frequency: Over 24 hours; the infusion rate is usually 40 ml/kg/24h in adults, the elderly and adolescents
Pinned product: Ringers Solution for Infusion. §4.2 verbatim: 'The recommended dosage is: - for adults, the elderly and adolescents : 500 ml to 3 litres /24h - for babies and children : 20 ml to 100 ml / kg / 24 h.' and 'The infusion rate is usually 40 ml/kg/24h in adults, the elderly and adolescents.' and 'Infusion rate and total volume can be higher in surgery or in case of need.' The label prints NO maximum, so none is given here. Infusion rate and volume depend on age, weight, clinical condition (e.g. burns, surgery, head-injury, infections) and concomitant therapy and are determined by the consulting physician. NOT A POTASSIUM OR CALCIUM REPLACEMENT: §4.4 'contains insufficient concentration of potassium and calcium to be used for maintenance of these ions or to correct their deficits. Hence, after dehydration is treated, the IV fluid has to be changed to a maintenance fluid that will provide these ions.' Fluid balance and plasma electrolytes (sodium, potassium, calcium, chlorides) must be monitored during administration. CEFTRIAXONE: contraindicated in preterm and term newborn infants (<=28 days) even via separate lines; in patients older than 28 days (including adults) it must not be given simultaneously with calcium-containing IV solutions, even via different lines or sites. Do not give through the same infusion set as a blood transfusion (risk of coagulation). Some sections of the product information we used were incomplete — check the full SPC.

Paediatric dose

Route: Intravenous infusion
Frequency: 20 ml to 100 ml/kg per 24 hours (babies and children)
RANGE, NOT A SINGLE PER-KG DOSE — dosePerKg is deliberately null; do not pick a point inside the range. §4.2 verbatim: 'for babies and children : 20 ml to 100 ml / kg / 24 h.' Rates, verbatim: 'In paediatric patients the infusion rate is 5 ml/kg/h on average but the value varies with age: 6-8 ml/kg/h for infants, 4-6 ml/kg/h for toddlers, and 2-4 ml/kg/h for schoolchildren.' Age bands as the label defines them: 'infants and toddlers: aged from 28 days to 23 months ... children and schoolchildren: aged from 2 years to 11 years.' The label prints no figure for neonates (28 days or younger) and none is given here. Volume and rate must be determined by a physician experienced in paediatric intravenous fluid therapy (§4.2). The SPC also prints burn-specific and head-injury-specific paediatric figures, which are not reproduced because this page is not specific to those uses — see the SPC. Ceftriaxone is contraindicated with this solution in newborns (28 days or younger).

Dose adjustments

Renal

No numeric renal dose adjustment is printed. §4.3: contraindicated in severe renal insufficiency (with oliguria/anuria). §4.4: 'Ringer's Solution should be administered with particular caution, to patients with or risk of severe renal impairment. In such patients, administration of Ringer's Solution may result in electrolyte abnormalities'; also give cautiously with impaired renal function or calcium renal calculi.

Hepatic

No numeric hepatic dose adjustment is printed. §4.3: contraindicated in 'General oedema and ascitic cirrhosis'. §4.4: patients with heart-, liver- and kidney diseases are at particular risk of acute hyponatraemia on infusion of hypotonic fluids.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Extracellular hyperhydration or hypervolaemia
  • Hypertonic dehydration
  • Hyperkalaemia
  • Hypernatraemia
  • Hypercalcaemia
  • Hyperchloraemia
  • Severe renal insufficiency (with oliguria/anuria)
  • Uncompensated cardiac failure
  • Severe hypertension
  • General oedema and ascitic cirrhosis
  • Concomitant digitalis therapy
  • Treatment with ceftriaxone in preterm newborn infants and term newborn infants (28 days of age or younger), even if separate infusion lines are used (risk of fatal ceftriaxone-calcium salt precipitation in the neonate's bloodstream)

Side effects

  • Hyperhydration (very common; in patients with cardiac disorder or pulmonary oedema)
  • Electrolyte disturbances (very common)
  • Heart failure (very common; in patients with cardiac disorder or pulmonary oedema)
  • Hospital acquired hyponatraemia (frequency not known) — may cause irreversible brain injury and death through acute hyponatraemic encephalopathy
  • Acute hyponatraemic encephalopathy (frequency not known)
  • Fluid overload, hypersensitivity and urticaria have been reported with other similar solutions
  • Related to the administration technique: febrile response, infection at the site of injection, local pain or reaction, vein irritation, venous thrombosis or phlebitis extending from the injection site, and extravasation
  • If an adverse reaction occurs the infusion must be discontinued

Interactions

  • Ceftriaxone — contraindicated in newborns (28 days or younger) even via separate lines; in patients older than 28 days (including adults) must not be given simultaneously with calcium-containing IV solutions, even via different infusion lines or sites (§4.4, §4.5)
  • Corticoids/steroids and carbenoxolone — associated with retention of sodium and water (oedema and hypertension) (§4.5)
  • Potassium-sparing diuretics (amiloride, spironolactone, triamterene), ACE inhibitors and, by extrapolation, angiotensin II receptor antagonists, tacrolimus, ciclosporin — increase plasma potassium (§4.5)
  • Digitalis — concomitant therapy is a contraindication (§4.3)
  • Vasopressin agonists / non-osmotic vasopressin release (SIADH) — risk of hospital acquired hyponatraemia (§4.2, §4.4)
  • Note: §4.5 was cut off at the source-fetch limit part-way through the potassium-related interactions, so this list is not complete — consult the full SPC

Monitoring

  • Fluid balance and plasma electrolyte concentrations (sodium, potassium, calcium, chlorides) must be monitored during administration (§4.2)
  • Serum sodium, particularly in patients with non-osmotic vasopressin release (SIADH) and those on vasopressin agonists, because of the risk of hospital acquired hyponatraemia (§4.2)
  • Take care to prevent extravasation during intravenous infusion because of the calcium content (§4.4)
  • Plasma electrolyte concentrations should be closely monitored in the paediatric population (§4.4)
  • Pregnant women during labour: serum sodium, particularly if given with oxytocin (§4.6)

Clinical monograph

How it works

It restores extracellular fluid volume and supplies sodium, potassium, calcium and chloride ions in physiological proportions to correct or prevent depletion and maintain electrolyte balance.

Prescribing in practice

  • Because it contains potassium, avoid or use with great caution in renal impairment, hyperkalaemia or conditions predisposing to potassium retention, as accumulation can precipitate dangerous arrhythmias.
  • The calcium content makes it incompatible with co-administration of blood products through the same line, as it can promote clotting of citrated blood.
  • Use with caution in cardiac failure, oedematous states and hypertension where the sodium and volume load may worsen fluid overload.

Monitoring

Monitor serum electrolytes, fluid balance and renal function during infusion, especially in those at risk of potassium retention or fluid overload.

Counselling the patient

  • Explain that this is a drip to replace body fluids and salts.
  • Report breathlessness, swelling or palpitations during the infusion.

Evidence & guidelines

Balanced crystalloids of this type are established for perioperative and resuscitation fluid replacement, with guidance favouring balanced solutions over excessive use of sodium chloride alone in many settings.

Reference: NICE CG174; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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