Ringerfundin B.

Braun
Balanced Fluid Therapy

Fluid Administration

Less complexity. More therapeutic diversity with a plasma adapted solution.

Ringerfundin B. Braun*
Reduce complexity. Treat effectively.
Have you ever asked yourself why we still use normal saline, Ringers and Hartmans solution especially for the perioperative setting, although there are alternatives available? Ringerfundin B. Braun A balanced electrolyte solution for fluid substitution. Ringerfundin B. Braun has an isotonic electrolyte composition resembling human plasma. Its essential anions are metabolized in all organs and muscles with minor oxygen-consumption. The potential base excess is 0 mmol/l. Could you ever expect a better safety margin for your patients? Ringerfundin B. Braun the next step in fluid therapy!

1.4 lO consumption 21.4 lO 2-consumption per l solution per l solution

286 H2O 286 mosmol/kg mosmol/kg H O

2

BE =00 mmol/l BEpot= mmol/l

pot

+ Na 140 mmol/l Na 140 mmol/l

+

+ K 4mmol/l mmol/l K 4
+

The infusion solution innovation

Fluid Administration Safety benefits Gentle anion metabolism: In organs and muscles, low additional oxygen-consumption Isotonic solution resembling human plasma: Reduced danger for critical patients Neutral acid-base balance: Less risk of induced alkaloses or acidoses Plasma electrolyte concentrations: Less unintended corrections
. Braun B n i d n erfu g n i R

* other European brandnames: Sterofundin iso, Isofundin

Low oxygen-consumption
Ringerfundin B. Braun is gentle on your patient's metabolism
To metabolize anions, the body needs oxygen. A perioperative patient consumes around 15 l of oxygen per hour. The lungs and the cardiovascular system have to work hard to fulfill those needs. Any additional increase in oxygen consumption, for example if fever develops, can critically stress the body. When a solution containing metabolizable anions is infused, the body needs to consume more oxygen. Fluid replacement should subtract not add stress factors to the equation. When Ringerfundin B. Braun is infused, only 1.4 l of oxygen per liter solution are needed for bicarbonate metabolism. Common full electrolyte solutions make the body consume up to nearly 3 times more oxygen than with Ringerfundin B. Braun. Ringerfundin B. Braun is also gentle on the liver. The essential anions in Ringerfundin B. Braun, acetate and malate unlike lactate are metabolized in all organs and muscles.

Thanks to the outstanding metabolic properties of acetate and malate anions, Ringerfundin B. Braun uses up only one-third of the oxygen of other full electrolyte solutions.1

1. Zander R. Website, www.physioklin.de

Fluid Administration Harry W., 65 years old Gastric hemorrhage, endoscopy

Blood pressure 80/50, known coronary vessel disease Initial volume settlement with 2 l Ringerfundin B. Braun in the first hour Due to Ringerfundin B. Braun reduction of oxygenconsumption up to 5.2 l per hour compared to other solutions Total additional consumption of oxygen is reduced for up to 30% in the acute phase

metabolism n o i n ea l t n Ge
Low oxygen-consumption Its anions are metabolized in all organs and muscles Less stress on the body Not limited by tissue hypoxia

Isotonic solution
Ringerfundin B. Braun minimizes risks
Infusion of a hypertonic solution can shift the fluid balance from the intracellular to the extracellular spaces. Conversely, a hypotonic solution potentially causes water to shift to the intracellular spaces. Thus, hypotonic solutions pose risks: Cerebral edema can easily develop in preterm and newborn infants whose body composition is made up of 25% brain matter 2. In the USA an estimated 15,000 deaths a year 3,4 are attributed to postoperative hyponatremia secondary to the infusion of hypotonic solutions. Pediatricians recommend that only full electrolyte solutions be given for perioperative fluid therapy 5. In neurotraumatology, the use of hypotonic solutions, such as Ringer's lactate, should be avoided due to the risk of an increase of cerebral edema6. Compared to many hypotonic infusion solutions routinely used in clinical practice, Ringerfundin B. Braun is isotonic. This means increased safety for you and your patients!
2. Holzki J, Hering F: Volumenersatz in der Pdiatrie Volumenersatztherapie (Boldt J, Hrsg), Thieme, Stuttgart 2001 3. Arieff AI: Editorial: Postoperative hyponatraemic encephalopathy following elective surgery in children Pediatric Anaesthesia 1998; 8: 1-4 4. Ayus JC, Arieff Al: Brain damage and postoperative hyponatremia Neurotraumatology 1996; 46: 323-328 5. Pla et al.: Kristalloide Volumenersatztherapie (Boldt J, Hrsg), Thieme, Stuttgart 2001 6. Hennes H-J: Schdel-Hirn-Trauma Neuroansthesie (Jantzen J-P, Lffler W, Hrsg), Thieme, Stuttgart 2000

With an osmolarity of 304 mosmol/l and osmolality of 286 mosmol/kg H2O, Ringerfundin B. Braun is isotonic.1

Fluid Administration Jannik S., 4 years Appendectomy, infant surgery, ward

Balance of fluids during lack of food Perioperatively 3-6 ml Ringerfundin B. Braun per kg bodyweight and hour Reduced danger of cerebral side effects via isotonic qualities compared to hypotonic solutions

Benefits of isotonic solutions Increased safety for critical patients, e.g. infants and neurotrauma patients Less danger of hyponatremia

n o i t u l o s c i n Isoto

Balanced base excess

No change of the patients acid-base status
Infusion solutions not buffered with the physiological bicarbonate can cause dilutional acidoses. Adding the right concentration of metabolizable anions can prevent this complication. In opposite to lactate, the anions in Ringerfundin acetate and malate do not interfere with the plasma lactate level. Ringerfundin has no influence on lactate monitoring. In addition: Ringerfundin B. Braun is the first infusion solution with a potential base excess of 0 mmol/l. This innovative fluid reduces the risk of alkaloses or acidoses.
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26

With a potential base excess of 0 mmol/l acid-base status is less influenced by Ringerfundin B. Braun.1

Neutral

acid-base balance

Fluid Administration Susan M., 45 years old Malfunction of liver, internal medicine
Chronic Hepatitis C, poor bad general condition, lack of liquid 150 ml Ringerfundin B. Braun per hour In comparison to other solutions no unintended increase of lactate Proven utilization of the anions acetate and malate in the muscles

Benefits Reduced danger of alkaloses or acidoses No influence on lactate monitoring

Electrolyte composition
Electrolyte balance like in human plasma
Full electrolyte solutions are chiefly used for short-term treatment of hypovolemia and for long-term fluid replacement and must have a physiological composition closely resembling human plasma. Many conventional infusion solutions can produce a number of corrective effects both unintended and unknown. Ringerfundin B. Braun is composed of an electrolyte concentration as in human plasma, particularly sodium and potassium. Ringerfundin B. Braun does not affect electrolyte equilibrium, but promotes the body's self-regulation.

like in human plasm e c n a l a te ba y l o tr Elec

Plasma adapted electrolyte concentrations of Ringerfundin B. Braun (e.g. for Na+) prevent unintended corrections.1

 resembling human plasma

Marie P., 75 years old Femoral neck fracture, general surgery
After downfall several fractures and sprains. Co-morbidity: Cardiac insufficiency Continuous infusion of Ringerfundin B. Braun Infusion of plasma equivalent Ringerfundin B. Braun solution prevents unintended corrections also during long-term therapy

Benefits of electrolyte balance Plasma equivalence of most important electrolytes (e.g. Na+, K+) Less unintended corrections

Fluid Administration

Acetate-, Malate21.4 l O2 per l solution 286 mosmol/kg H2O

BEpot= 0 mmol/l Na+ 140 mmol/l K+ 4 mmol/l

Fluid Administration

Fluid Administration
Ringerfundin B. Braun
Composition 1000 ml Ringerfundin B. Braun solution for infusion contain: Sodium chloride Potassium chloride Magnesium chloride hexahydrate Calcium chloride dihydrate Sodium acetate trihydrate L-Malic acid Excipients Water for injections Electrolyte concentrations: Sodium Potassium Magnesium Calcium Chloride Acetate Malate Theoretical Osmolarity pH mmol/l 140.0 4.0 1.0 2.5 127.0 24.0 5.0 304 mosm/l 4.6-5.4 6,80 g 0.30 g 0.20 g 0.37 g 3.27 g 0.67 g Contraindications Ringerfundin B. Braun must not be administered in the following situations: Hypervolemia Severe congestive cardiac failure Renal failure with oliguria or anuria Severe general edema Hyperkalemia Hypercalcemia Metabolic alkaloses Special warning and precautions for use Monitoring of the serum electrolytes, fluid balance, and pH is necessary. Pregnancy and lactation There are no data from the use of Ringerfundin B. Braun in pregnant and lactating woman. In the intended indication no risks have to be expected, when volume, electrolyte and acid/base levels are carefully monitored. Ringerfundin B. Braun should be used with caution in toxemia of pregnancy. Undesirable effects Hypersensitivity reactions characterized by urticara have been occasionally described after the intravenous administration of magnesium salts. Although oral magnesium salts stimulate peristalsis, paralytic ileus has been rarely reported after intravenous infusion of magnesium sulphate. Adverse reactions may be associated to the technique of administration including febrile response, infection at the site of injection, local pain or reaction, vein irritation, venous thrombosis or phlebitis extending from the site of injection and extravasation. Adverse reactions may be associated to the medications added to the solution; the nature of the additive will determine the likelihood of any other undesirable effects. Status Only available on prescription Marketing Autorisation Holder B. Braun Melsungen AG 34209 Melsungen, Germany Version 03.2007

Indications Replacement of extracellular fluid losses in the case of isotonic dehydration, where acidosis is present or imminent.

B. Braun Melsungen AG 34209 Melsungen Germany Tel +49(0) 56 61 71-0

B. 02. 03. 07/2 Nr. 606 4023

www.bbraun.com