Clinical Case Scenario
A 60-year-old woman presents to the emergency department with persistent vomiting for 5 days. She has a history of hypertension, dyslipidaemia, chronic knee osteoarthritis, and pyloric stenosis due to long-term NSAID use. In the ED, she develops hypotension (BP 80/54 mmHg) and tachycardia (HR 115 bpm). On bedside POCUS assessment, her IVC diameter is 0.5 cm, which is collapsing to 30%. Lab results show:
Na⁺: 132 mmol/L
K⁺ : 2.8 mmol/L
Cl⁻ : 82 mmol/L
HCO₃⁻ : 38 mmol/L
pH: 7.52
Lactate: 4 mmol/L
Urea: 20 mmoL/L
Creatinine: 155 micromol/L (Baseline creatinine 95 micromol/L)
The ICU team advises aggressive resuscitation with 0.9% normal saline. After four litres of fluid administration along with 40 mmol of IV potassium chloride, BP improves to 102/64 mmHg, and follow-up labs are as follows:
Na⁺ : 135
K⁺ : 3.1 mmol/L
Cl⁻ : 97 mmol/L
HCO₃⁻ : 33 mmol/L
pH: 7.47
Lactate : 2.5 mmoL/L
Which one of the following is the correct statement regarding fluid resuscitation in this patient?
