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They add water to only a portion of the powder, though this is technically imprecise and not recommended for exact dosing

Journal of Hypertension, 27(Suppl 4), S17- S20

Aggressive Intravenous Hydration Protocol of Lactated Ringers for Acute Pancreatitis Source: Frontiers in Medicine Summary: A clinical meta-analysis assessing whether aggressive IV hydration (versus standard protocols) using lactated Ringers can reduce systemic inflammatory response, complications, and length of hospital stay in acute pancreatitis

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