A patient with peptic ulcer presents with hypovolemic shock (BP 84/60 mmHg). What is the fluid of choice for initial management?

Appeared in: NORCET 10 Mains

Explanation

The patient is in hypovolemic shock, a life-threatening condition caused by a loss of blood or fluid, leading to low blood pressure and inadequate tissue perfusion.
The immediate goal of treatment is to rapidly restore circulating blood volume.
Isotonic crystalloid solutions, such as Normal Saline (0.9% NaCl) and Ringer's Lactate (LR), are the first-line fluids for initial resuscitation.
These fluids have a tonicity similar to that of blood plasma, which means they stay within the intravascular space to effectively and quickly increase blood volume and pressure.

Option B: This is a hypotonic solution once the dextrose is metabolized. It would cause fluid to shift from the intravascular space into the cells, worsening the shock by further decreasing the circulating volume.
Option C: This is a hypertonic solution used primarily to correct hypoglycemia. It is not a volume expander and can worsen dehydration by causing an osmotic diuresis (increased urine output).
Option D: D5NS is a hypertonic solution. While it contains Normal Saline, the added dextrose makes it less ideal for rapid, large-volume resuscitation in a patient who is not hypoglycemic. It can lead to hyperglycemia.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Fluid resuscitation for hypovolemic shock in acute care settings.
Recognizing and treating hypovolemic shock is a critical nursing skill. The nurse is often the first to identify signs of shock and initiate life-saving interventions.
A key nursing action is to establish two large-bore (16-18 gauge) IV catheters to allow for rapid administration of fluids and potentially blood products.
Continuous monitoring of the patient's response is vital. A positive response includes an increase in blood pressure, a decrease in heart rate, and an increase in urine output to at least 30 mL/hr.

How to Approach the Question

First, identify the patient's primary problem from the clinical data provided. The BP of 84/60 mmHg indicates hypotension and, in this context, hypovolemic shock.
Next, determine the immediate therapeutic goal. For hypovolemic shock, the goal is rapid expansion of the intravascular fluid volume.
Evaluate each IV fluid option based on its tonicity and its effect on fluid shifts in the body.
Recall that isotonic solutions (like NS and LR) are the standard for initial volume resuscitation because they remain in the vascular space.
Eliminate hypotonic solutions, which would shift fluid out of the vessels, and hypertonic solutions, which are used for specific conditions like hypoglycemia or cerebral edema and are not first-line for volume expansion.

Concept Tested & Keywords

Concept Tested: Fluid resuscitation for hypovolemic shock
Stem keywords: peptic ulcer, hypovolemic shock, BP 84/60 mmHg, initial management, fluid of choice
Lead-in keywords: What is the fluid of choice
Clinical cues: The patient's blood pressure of 84/60 mmHg is a clear sign of hypotension, a hallmark of shock requiring immediate intervention.
Negative lead-in flag: false

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 142-144

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 575-577

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