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What Is The Risk Of Hypervolemia When Suffering From Chronic Cardiac Failure?

Posted on Mon, 20 Oct 2014

Question: Patient has chronic cardiac failure, COPD, type 2 diabetes, pleural effusion, hypoxia, pneumonia, is hypotensive and dehydrated. I understand that it is not the normal practice to use an IV fluid with NORMAL saline if the patient also has hypernatremia (e.g. sodium 146 mmol/L,150 mmol/L, 157 mmol/L) and renal impairment because of the risk of hypervolemia. But is this only a theoretical risk given the patient's conditions or should the risk be taken seriously? Are there any risks regarding chronic cardiac failure?

Answered by Dr. Benard Shehu (1 hour later)

Brief Answer:
It's theoretical risk but should be taken seriously..

Detailed Answer:
Hi,

This is more a theoretical risk given to the patient condition but it should be taken seriously. If your doctor decide to administer saline infusion this should be done with care and under strict medical control.

If she was my patient I would prefer to give her dextrose 5% and dobutamine in order to stabilize her tension. This will improve her cardiac failure and renal function.

Hope this was of help!
Dr. Benard

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Benard Shehu (11 hours later)

Thank you Dr Shehu. If the patient suddenly becomes much more hypotensive, e.g. BP suddenly becomes 85/56 and the patient is taken off Lasix (frusemide) would it matter if normal saline solution is still used for the IV fluid? That is, considering the BP is so low, could the normal saline solution be warranted to try keep the BP higher? Would there still be a risk of hypervolemia? Could further damage be done to the cardiac and renal function even if there isn't hypervolemia?

Answered by Dr. Benard Shehu (16 hours later)

Brief Answer:
There is a risk for hypervolemia...

Detailed Answer:
Hi and welcome back!

Unfortunately there is a risk for hypervolemia if normal saline is used in this case and saline infusion isn't the best way to treat hypotension.

In such a case as I mentioned earlier i recommend starting dobutamin with low dose to improve cardiac and renal function.

If there's no hypervolemia then no other known side effects and contraindication for normal saline.

Hope this answered all your queries!
Wish you health!
Dr. Benard

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj