The myth that LR should be avoided in hyperkalemia is not only incorrect, it is probably backwards. For a hyperkalemic patient in renal failure, Lactated Ringers (LR) should be preferred over normal saline (NS). LR has been proven to produce lower potassium levels en vivo.

Understanding the effect that a crystalloid will have on serum potassium concentrations involves considering effects on acid-base physiology and intracellular potassium shifts, which are more important than the amount of potassium in the plastic bag.

LR is not necessarily the best fluid for a patient with hyperkalemia.

For a patient with hyperkalemia and metabolic acidosis, isotonic bicarbonate is probably superior to LR as it may cause a greater decrease in serum potassium.

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