Case 4 Pearls

• Ideally, this patient should be given intravenous fluids because of the presence of prerenal azotemia.

• Fluid loading, however, is hazardous in a patient with compromised cardiac function.

• Fluid therapy should be started at a maintenance rate of 253 ml/day (approximately 11 ml/hour). If the azotemia does not resolve with this volume of fluid, the rate of administration may need to be increased.

• The fluid of choice in a patient with compromised cardiac function is 0.45% NaCl plus 2.5% dextrose, or 5% dextrose (D₅W) solution that contains a low level of sodium is required because of the sodium-retaining state induced by the presence of congestive heart failure.