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Resuscitation with Lactated Ringer’s Solution After Hemorrhage: Lack of Cardiac Toxicity

Author: Delman K. Malek SK. Bundz S. Abumrad NN. Lang CH. Molina PE, Department of Surgery, State University of New York at Stony Brook

Publication: Shock. 5(4):298-303, 1996 Apr

The toxicity of D-lactate has been recognized for almost 30 years. This compound is found in the racemic mixture of lactated Ringer’s solutions routinely used for peritoneal dialysis and the resuscitation of trauma victims. The current study was designed to investigate whether toxicity occurred at the D-lactate concentrations achieved during hemorrhage resuscitation with racemic lactated Ringer’s solution. Conscious unrestrained male Sprague-Dawley rats (n = 24) were monitored for electrocardiographic abnormalities while undergoing hemorrhage and subsequent resuscitation with either L-lactated, D-lactated, or racemic lactated Ringer’s solution. The rats infused with D-lactate showed significant toxicity as evidenced by bradycardia, premature ventricular contractions, and ventricular fibrillation. No such alterations were observed in the animals resuscitated with L-lactate or racemic solutions. Resuscitation with the racemic lactate mixture increased the D-lactate concentrations in the blood, but was not associated with overt changes in cardiac rhythm. The infusion of the different resuscitation fluids produced few significant differences in acid-base status of hemorrhaged rats. These findings indicate that although toxicity may be achieved with a Ringer’s solution containing only D-lactate, resuscitation using the racemic mixture does not achieve D-lactate concentrations high enough to be detrimental to the animal.

Three Army soldiers were on their way to us following an explosion of an improvised device.  The driver had goggles on and suffered extensive facial trauma and all three had eye injuries from the debris that hit them.  We got bilateral Morgan Lenses in all three and flushed each with several liters of LR.  Followed with antibiotics, they were rebandaged and on an emergency air evacuation that evening.  These men were grateful for the care they received.  The technicians and physicians here are thankful that everyone knew what to do to get the lens system set up and running.  I am grateful to you for the opportunity to access the class online and ability to present it shortly after we arrived.  One of the others did have a corneal laceration that we could assess after flushing.  We feel confident that all will have the best outcomes thanks to the Morgan Lens use.


We also had a patient who experienced an electrical explosion (a generator) to his face.  We used Morgan Lenses to irrigate his eyes and sent him on an air evacuation flight to Germany.  He has since returned to duty and is doing well with minimal residual sight loss.                                   

Military Registered Nurse (Active Duty)

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Why Use The Morgan Lens?

The Morgan Lens is used in 90% of hospital emergency departments in the USA and can be inserted in less than 20 seconds. There simply is no other "hands-free" method of eye irrigation. Nothing else frees medical personnel to treat other injuries or to transport the patient while irrigation is underway. Nothing is more effective at treating ocular chemical, thermal, and actinic burns or removing non-embedded foreign bodies, even when the patient's eyes are closed tightly. Its design makes it simple and straightforward to use so minimal training is required.