In a patient with heart failure, which approach to IV fluids is preferred?

• A. Increase IV fluids
• B. Maintain a normal fluid balance
• C. Use diuretics to remove fluid
• D. Do not use IV fluids; focus on removing fluid

Answer: (D)

In heart failure with fluid overload, the priority is to reduce total body fluid and relieve congestion. Giving IV fluids would add volume to an already congested system, increasing preload and worsening edema and pulmonary symptoms. The best approach is to avoid additional IV fluids and focus on removing excess fluid, typically with diuretics, along with fluid restriction and careful monitoring of intake and output. Loop diuretics (often given IV if needed) promote rapid diuresis and help decrease pulmonary and peripheral edema, which can improve breathing and tissue perfusion. If the patient showed signs of hypoperfusion or hypotension, fluid administration might be needed, but for congestion-dominant heart failure, removing fluid is the key strategy. Monitor daily weights, lung sounds, edema, electrolyte levels, and I&O to guide therapy and ensure you’re not overdiuresing.