An adolescent weighing 42 kg has a urine output of 520 mL over 8 hours.

What is the patient's actual urine output in milliliters per kilogram per hour (mL/kg/hr)? Round your answer to the nearest tenth and enter only digits (not units). —

Choice A rationale

Furosemide is a loop diuretic that promotes the excretion of sodium and water, reducing fluid overload and pulmonary congestion associated with congestive heart failure. A decreased urine output of 0.5 mL/kg/hr is a sign of worsening status, as the target output for adequate diuresis is generally 1-3 mL/kg/hr for children.

Choice B rationale

Furosemide therapy is intended to reduce fluid volume, which should result in weight loss. An increase in weight of 1.5 kg indicates fluid retention and ineffective or inadequate diuretic therapy, signaling a deterioration or lack of improvement in the child's congestive heart failure.

Choice C rationale

A decrease in respiratory rate from 50 to 32 breaths per minute indicates a reduction in tachypnea. Tachypnea in congestive heart failure is caused by fluid backup into the lungs (pulmonary congestion), which decreases lung compliance. The reduction in rate suggests that the diuretic has successfully lowered the pulmonary fluid volume, improving respiratory function.

Choice D rationale

An increase in heart rate to 160 bpm (tachycardia) in a school-aged child (normal resting heart rate ≈ 70-110 bpm) is a compensatory mechanism for decreased stroke volume, often seen in worsening heart failure or dehydration. This finding indicates deterioration or a negative effect of the diuretic, such as volume depletion.

Choice A rationale

Hypotonic saline is not the fluid of choice for septic shock because it lowers serum osmolality and can shift fluid into the cells, worsening intravascular volume depletion and hypotension. A 20 mL/kg bolus is the correct volume, but the fluid type and 10 minutes duration are inappropriate for initial resuscitation.

Choice B rationale

The volume of 5 mL/kg is insufficient for the initial resuscitation of a child in septic shock, where the goal is rapid, aggressive replacement of intravascular volume lost due to capillary leak and vasodilation. A 20 mL/kgbolus is the standard. Ringer's lactate is an acceptable crystalloid, but the volume is wrong.

Choice C rationale

𝐃5𝐖 (5.

Choice D rationale

0.9% 𝐍𝐚𝐂𝐥 (𝐧𝐨𝐫𝐦𝐚𝐥 𝐬𝐚𝐥𝐢𝐧𝐞) is an isotonic crystalloid and is the preferred initial fluid choice to expand the intravascular volume rapidly without risk of electrolyte shift. The dose of 20 mL/kgis standard and must be administered rapidly, typically over 5-30 minutes, to correct hypovolemia and improve cardiac output.