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In trauma or surgery which of the following fluids should be avoided?

 # In trauma or surgery which of the following fluids should be avoided?
A. 5% Dextrose
B. Isotonic saline
C. Ringer lactate
D. Blood


The correct answer is B. Isotonic saline.

Hypovolemic shock due to hemorrhage results in cellular anaerobic metabolism and lactic acidosis. This acidosis leads to decreased function of the coagulation proteases, resulting in coagulopathy
and further haemorrhage.  Underperfused muscle is unable to generate heat and hypothermia ensues. Coagulation functions poorly at low temperatures and there is further haemorrhage, further hypoperfusion and worsening acidosis and hypothermia. These three factors result in a downward spiral leading to physiological exhaustion and death. 

Intravenous blood and fluids are cold and exacerbate hypothermia. Further heat is lost by opening body cavities during surgery. Surgery usually leads to further bleeding and many crystalloid
fluids are themselves acidic (e.g. normal saline has a pH of 6.7). 

So, identification and stoppage of hemorrhage should be done immediately and physiological exhaustion from coagulopathy, acidosis and hypothermia should be avoided or limited. 


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