# Allergy to Ringer’s Lactate - Uncommon Cause of Anaphylaxis during Intraoperative Period: A Case Report

## TL;DR

A rare case of anaphylaxis during surgery was caused by Ringer’s Lactate, highlighting the need for awareness of hypersensitivity to this commonly used fluid.

## Contribution

This case report documents a rare intraoperative anaphylactic reaction to Ringer’s Lactate, expanding the understanding of its potential as an allergen.

## Key findings

- A 27-year-old patient developed anaphylaxis symptoms during surgery after Ringer’s Lactate infusion.
- Discontinuation of Ringer’s Lactate and switching to normal saline led to rapid improvement.
- A postoperative subcutaneous challenge confirmed Ringer’s Lactate as the allergen.

## Abstract

Perioperative anaphylaxis is a rare but potentially fatal event, with an incidence ranging from 1:300 to 1:20,000 surgeries and a mortality rate of 3-9%. Its intraoperative occurrence is diagnostically challenging due to patient sedation and overlapping drug effects. Crystalloids like Ringer’s Lactate are rarely implicated. A 27-year-old American Society of Anesthesiologists grade I female undergoing mastoidectomy developed intraoperative hypotension, tachycardia, and generalized erythema after induction with standard anesthetics and Ringer’s Lactate infusion. Anaphylaxis was suspected, and Ringer’Lactate was discontinued. The patient improved rapidly upon switching to normal saline. A subcutaneous challenge postoperatively confirmed Ringer’s Lactate as the trigger. This case highlights an uncommon but serious hypersensitivity to Ringer’s Lactate. Clinicians must maintain high suspicion for all agents, including crystalloids, during Perioperative anaphylaxis. Prompt recognition, discontinuation of the offending agent, and supportive treatment are crucial. Given the widespread use of Ringer’s Lactate, awareness of this rare reaction is essential to prevent misdiagnosis and ensure patient safety.