You are working in the ICU and have just been notified that you are receiving a patient from the Obstetrics unit who is in hypovolemic shock due to massive blood loss during delivery

Question

You know that the best choice for fluid replacement for this patient is what?
A) 5% Albumin because it is inexpensive and is always readily available
B) Dextran because it increases intravascular volume and counteracts coagulopathy
C) Whatever fluid that is most readily available in the ICU, due to the nature of the emergency
D) Lactated Ringer's solution because it increases volume, buffers acidosis, and is the best choice for patients with liver failure

Answer 1

Ans: C
Feedback: The best fluid to treat shock remains controversial. In emergencies, the "best" fluid is often the fluid that is readily available. Fluid resuscitation should be initiated early in shock to maximize intravascular volume. Both crystalloids and colloids can be administered to restore intravascular volume. There is no consensus regarding whether crystalloids or colloids like dextran and albumin should be used; however, with crystalloids, more fluid is necessary to restore intravascular volume. Option A is incorrect; albumin is very expensive and is a blood product so it is not always readily available for use. Option B is incorrect; dextran does increase intravascular volume, but it increases the risk for coagulopathy. Option D is incorrect; Lactated Ringer's is a good solution choice because it increases volume and buffers acidosis but should not be used in patients with liver failure because the liver is unable to covert lactate to bicarbonate.