In adult neurogenic shock, what fluid and volume is recommended?

• A. Normal Saline 250 ml
• B. Normal Saline 500 ml (Maximum 1L)
• C. Lactated Ringer's 1 L
• D. No fluid resuscitation unless hypotension develops

Answer: (B)

In adult neurogenic shock, the main issue is vasodilation with relative hypovolemia, so perfusion is helped by a careful volume strategy that restores return to the heart without pushing fluids too aggressively. The best approach is to give a modest isotonic saline bolus and reassess promptly. Start with about half a liter and monitor blood pressure, heart rate, and signs of perfusion. If the patient remains hypotensive after the initial response, repeat the bolus up to a total of roughly a liter. This targeted fluid approach quickly supports preload and blood pressure while minimizing the risk of fluid overload in the setting of autonomic dysfunction. If hypotension persists after the fluid challenge, vasopressor support should be considered.