In adult non-fatal drowning who is hypotensive with clear lung sounds, what is the recommended Normal Saline bolus?

• A. Normal Saline: 1 L Bolus
• B. Normal Saline: 20 mL/kg Bolus
• C. Normal Saline: 2 L Bolus
• D. Normal Saline: 500 mL Bolus

Answer: (A)

In this scenario, the main idea is restoring circulating volume without risking fluid overload. When an adult who has had non-fatal drowning is hypotensive but has clear lung sounds, the lungs aren’t flooded, so you can give IV fluids to improve perfusion without immediately worrying about pulmonary edema.

The recommended approach is a 1 liter bolus of Normal Saline given promptly, then reassess the patient’s blood pressure, perfusion, and signs of overload. This amount provides a solid initial volume to raise blood pressure and improve circulation without overdoing it. Larger total volumes, such as 2 liters or a heavier weight-based amount like 20 mL/kg (which can be around 1.4 liters for many adults), increase the risk of fluid overload and potential delayed pulmonary complications. A smaller dose, like 500 mL, is more likely insufficient to correct hypotension promptly.

After the bolus, continue to monitor and repeat fluids if needed, tailoring further resuscitation to the patient’s response and any evolving signs of fluid overload.