Intravenous (IV) therapy, a common procedure, is the method of introducing fluids and medications into the body quickly, bypassing the digestive system. IV therapy as we know it is only about 100 years old.
Reports of attempts to introduce fluids via the IV route of administration dates to the Middle Ages. The first successfully reported attempt at IV therapy occurred in the 1600s by Christopher Wren, who used a pig’s bladder and writing quill to introduce IV fluids into a dog. Not much advancement happened for many years, but what Christopher Wren did was show it was possible. During the early 1830s Dr. Thomas Latta, a Scottish physician, was able to give a salt solution (saline) to cholera victims, which greatly improved their condition. A few years later Dr. James Blundell, an English obstetrician, gave blood transfusions to women who had postpartum hemorrhages.
This column is about the discovery of a specific IV solution. The story began in the 1880s when Sidney Ringer, a British physician, was studying the effects of various solutions on the contractility of frog hearts. The laboratory assistant for Dr. Ringer made an error by preparing a solution using tap water supplied by London’s New River Water Company, instead of using distilled water. When the error was discovered and the experiment repeated with the distilled water, Dr. Ringer noticed that the frog heart did not have the sustained contractility as when prepared with the tap water. The doctor deduced that the impurities in the tap water was the reason for the difference. When the tap water was analyzed, it was noted to contain minute amounts of calcium, potassium, sodium, and magnesium. A few years later, in the 1930s Alexis Hartmann, a pediatrician, added lactate to the solution to improve it by reducing acidosis formation. Today we know this widely used IV solution as Lactated Ringer’s Solution or LR for short. Today the contents of Ringer’s Lactate include sodium, chloride, potassium, calcium, and lactate in the form of sodium lactate. It is one of the most widely used IV solutions second only to normal saline. The reason it is so widely used is for the positive effects it has on fluid replenishment, especially during the stress of injury, trauma, or burn injury.
Modern medicine owes a great deal to pioneers in IV therapy like Sidney Ringer, Alexis Hartmann, and countless others. What we take for granted today was not available100 years ago. An additional fact of history is it was not until after the 1940s that nurses were allowed to administer IV fluids. Until then only physicians were permitted to give IV therapy.
We should value that when errors are made questions are asked and different effects noted. Thus was the case in the discovery of Lactated Ringer’s Solution, a truly beneficial part of modern medicine.
Stay informed and stay healthy.
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