A patient with a severe head injury (GCS 7) and elevated intracranial pressure requires intravenous fluid resuscitation for hypotension. Which fluid is most appropriate?

• A 5% Dextrose in water
• B 0.45% Saline
• C Ringer's lactate
• D 0.9% Normal saline ✓

Explanation

In traumatic brain injury, isotonic crystalloid such as 0.9% normal saline is preferred because it maintains intravascular volume without acutely lowering serum osmolality. Hypotonic fluids (5% dextrose, 0.45% saline) can worsen cerebral edema. Ringer's lactate is slightly hypotonic (sodium 130 mEq/L) and is generally acceptable, but normal saline is the standard choice in neurosurgical resuscitation. Avoiding hyperglycemia is also important, so dextrose-containing solutions are avoided.

Reference: Bailey & Love's Short Practice of Surgery, 28th ed.

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Written and medically reviewed by the StethoPrep medical team.