In shock one should preferably not use?

MP CHO-2018

Medical & Surgical Nursing

Hard

Appeared in: MP CHO-2018

Explanation

Dextrose 5% (D5W) is contraindicated for fluid resuscitation in shock.
Although isotonic in the bag, the dextrose is rapidly metabolized by the body, leaving behind free water.
This free water is hypotonic and moves into the intracellular space, failing to expand the intravascular volume needed to treat shock.
Using D5W for resuscitation can lead to dangerous complications like cerebral edema, hyponatremia, and intracellular fluid overload.

Option A: Normal Saline (0.9% NaCl) is an isotonic crystalloid solution and is a first-line fluid of choice for resuscitation in shock because it effectively expands the intravascular volume.
Option B: Dextrose Normal Saline (DNS) is a hypertonic solution that does expand intravascular volume. While not a first-line choice for initial bolus therapy due to the risk of hyperglycemia, it is not as fundamentally incorrect as D5W, which provides negligible volume expansion.
Option D: Ringer's Lactate (RL) is a balanced isotonic crystalloid solution. It is a first-line fluid of choice for resuscitation in many types of shock, similar to Normal Saline.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain IV fluid management in shock as background academic context rather than a clinical decision trigger.
Nurses must be able to rapidly identify the correct type of IV fluid for emergency situations like shock. Using the wrong fluid, such as D5W, can be ineffective and harmful.
A key nursing responsibility during fluid resuscitation is to continuously monitor the patient's response, including blood pressure, heart rate, urine output, and mental status, as well as watch for signs of fluid overload like crackles in the lungs or peripheral edema.
What if the patient has a traumatic brain injury (TBI) and is in shock? In this scenario, D5W is absolutely contraindicated as it would significantly increase intracranial pressure (ICP). Isotonic saline (0.9% NaCl) or even hypertonic saline (3% NaCl) would be used to restore volume while controlling ICP.

How to Approach the Question

First, identify the core clinical concept in the question: treating 'shock'. Recall that shock is a state of inadequate perfusion, and the immediate goal is to increase blood volume.
Next, analyze the question's constraint: which fluid should 'preferably not' be used. This requires you to evaluate the suitability of each option for volume expansion.
Evaluate each fluid based on its tonicity and how it behaves in the body. Remember that fluids used for resuscitation must stay in the intravascular space.
Recall that Normal Saline and Ringer's Lactate are standard isotonic crystalloids for resuscitation.
Critically assess Dextrose 5%. Remember that once the dextrose is used by cells, it becomes free water (hypotonic), which will not stay in the vessels to raise blood pressure. This makes it unsuitable and dangerous for shock resuscitation.
By comparing the physiological effects, you can conclude that Dextrose 5% is the fluid to be avoided.

Concept Tested & Keywords

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