A 65-year-old man with a history of congestive heart failure (ejection fraction 30%) is admitted for emergency repair of a strangulated inguinal hernia. He is hypovolemic with a blood pressure of 88/50 mmHg. Which intravenous fluid is the MOST appropriate initial resuscitation fluid in this patient?
- A 0.9% normal saline as a rapid bolus
- B 5% dextrose in water as a rapid bolus
- C A balanced crystalloid such as Ringer's lactate, given cautiously with haemodynamic monitoring ✓
- D Hydroxyethyl starch (HES) 6% solution
Correct answer: C. A balanced crystalloid such as Ringer's lactate, given cautiously with haemodynamic monitoring
Explanation
In a patient with heart failure requiring emergency surgery, a balanced crystalloid given cautiously with monitoring is safest. 0.9% saline in large volumes causes hyperchloraemic acidosis and volume overload. Dextrose distributes freely and worsens oedema without expanding plasma volume. Hydroxyethyl starch is contraindicated in heart failure and carries renal and mortality risks. Balanced crystalloids are the recommended resuscitation fluid in current guidelines.
Reference: Miller's Anaesthesia, 9th ed.
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