The nurse in the intensive care unit (ICU) has just received a patient from the obstetrics unit who is in hypovolemic shock due to massive blood loss during delivery. The nurse is aware that the best choice for fluid replacement will be:

Question

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 is most readily available in the ICU, due to the nature of the emergency
D) Ringer's lactated solution is used 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, as described later, 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 (Vincent, 2003). 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; Ringer's lactated 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 convert lactate to bicarbonate.