Hartmann's solution

Hartmann's solution or compound sodium lactate (CSL) is a crystalloid solution that is closely isotonic with blood and intended for intravenous administration. Hartmann's solution is used to replace body fluid and mineral salts that may be lost for a variety of medical reasons. It is especially suitable when the losses result in too much acid being present in the blood and is very similar—though not identical—to lactated Ringer's solution, the ionic concentrations of which differ slightly.

It is named after US paediatrician Alexis F. Hartmann (1898–1964).^[1]

Overview

One litre of Hartmann's solution contains:

• 131 mmol/L of sodium ion
• 111 mmol/L of chloride ion
• 29 mmol/L of lactate
• 5 mmol/L of potassium ion
• 2 mmol/L of calcium ion

This amounts to an osmolarity of 274 mOsm/L.^[2]

Generally, the sodium, chloride, potassium and lactate come from NaCl (sodium chloride), NaC₃H₅O₃ (sodium lactate), CaCl₂ (calcium chloride), and KCl (potassium chloride).

Hartmann's solution is given via an intravenous line (drip) and can be administered at various rates depending on the indication and urgency. Its pH is 6.5.

Contraindications

Hartmann's solution may be relatively contraindicated in patients with diabetes mellitus, as one of the isomers of lactate is gluconeogenic.^[3]

Side effects

Hands, ankles and feet may become mildly swollen from fluid retention. Rarely, the lungs can also be affected, which may cause breathing difficulty. Other possible symptoms include nausea, vomiting, headache, dizziness, drowsiness, confusion, and inflammation or swelling of the veins around the site of the injection.

References

1. "Hartmann's solution", Oxford Reference
2. http://www.frca.co.uk/article.aspx?articleid=291
3. D. J. B. Thomas AND K. G. M. M. Alberti, 'Hyperglycaemic effects of Hartmann's solution during surgery in patients with maturity onset diabetes', British Journal of Anaesthesia, (1978, 50, 185) - http://bja.oxfordjournals.org/cgi/content/abstract/50/2/185