From the Research
The best approach for fluid resuscitation in an elderly post-operative patient with hypotension is to start with a balanced crystalloid solution such as Lactated Ringer's or Plasma-Lyte at 250-500 mL boluses, reassessing after each bolus, and albumin should not be the first choice for fluid resuscitation due to lack of strong evidence supporting its use in this context 1. Initial fluid administration should be guided by clinical parameters including blood pressure, heart rate, urine output, mental status, and when available, dynamic measures of fluid responsiveness. A reasonable initial target is to maintain mean arterial pressure above 65 mmHg. Careful titration is essential as elderly patients have decreased physiologic reserve and are at higher risk for volume overload. If the patient remains hypotensive after 1-2 liters of crystalloid, vasopressors such as norepinephrine (starting at 0.05-0.1 mcg/kg/min) should be considered while continuing to assess fluid status, as suggested by recent studies on fluid resuscitation in critically ill patients 2, 3. Ongoing monitoring should include frequent vital signs, input/output measurements, daily weights, and laboratory values including electrolytes, BUN, creatinine, and lactate. This cautious approach balances the need to treat hypotension while avoiding complications of excessive fluid administration such as pulmonary edema, which elderly patients are particularly susceptible to due to age-related cardiac and renal function changes. Key considerations in choosing the type of fluid include the composition of the solution and its potential effects on acid-base balance and renal function, with balanced crystalloids being preferred over normal saline due to their more physiological composition 4, 5. Ultimately, the decision to use albumin or any other fluid should be based on the individual patient's needs and response to initial fluid resuscitation efforts, with a focus on minimizing morbidity, mortality, and improving quality of life.