A client is admitted to the hospital with hypoalbuminemia and shock.
The nurse is preparing to start an intravenous (IV) infusion.
Which of the following IV fluids is the most appropriate for this client?

Choice A rationale:

Thirst and dry mouth are early signs of dehydration.

When the body loses fluids, it signals the brain to increase thirst and conserve water.

Dry mouth can occur due to reduced saliva production when the body is dehydrated.

Choice B rationale:

Decreased urine output and dark-colored urine are indicators of concentrated urine, suggesting dehydration.

Reduced fluid intake or excessive fluid loss can lead to decreased urine production, and the urine becomes more concentrated, appearing darker than usual.

Choice C rationale:

Rapid heart rate and low blood pressure are signs of hypovolemic shock, a severe form of dehydration where the body cannot circulate enough blood to meet its needs.

This can happen in severe cases of dehydration when there is a significant loss of fluids and electrolytes.

Choice D rationale:

Poor skin turgor is a classic clinical sign of dehydration.

Skin turgor refers to the skin's ability to return to its normal position after being pinched.

In dehydrated individuals, the skin loses elasticity and remains tented or "pinched" after being pulled up.

This indicates a lack of fluid in the body.

Choice E rationale:

Increased energy and playfulness are not typical signs of dehydration.

Dehydrated children are more likely to be lethargic and irritable due to the physiological stress on their bodies.

The correct answer is B. Shakiness.

Choice A: Increased capillary refill Capillary refill time (CRT) is a simple and quick test requiring minimal equipment or time to perform. Prolonged CRT is a ‘red flag’ feature, identifying children with increased risk of significant morbidity or mortality. A normal CRT should be between 2-3 seconds when applied centrally, such as to the sternum or the forehead. Therefore, increased capillary refill is not typically associated with hypoglycemia.

Choice B: Shakiness Shakiness, or tremors, are rhythmic shaking movements that most often happen in the hands, but can also occur in the arms, legs, head, vocal cords, and torso. Tremors can occur while a child is resting or active. Shakiness is a common symptom of hypoglycemia.

Choice C: Thirst While it’s true that excessive thirst can be a sign of diabetes, it’s a tricky one when the patient is a child. Young children often drink plenty of fluids when they are perfectly healthy. However, thirst is typically associated with hyperglycemia, not hypoglycemia.

Choice D: Decreased appetite Loss of appetite (anorexia) is a common symptom in children. Acute illness in childhood is often associated with transient loss of appetite. However, decreased appetite is not typically a direct symptom of hypoglycemia.