For adults experiencing anaphylaxis, the recommended initial fluid resuscitation is 0.9% isotonic saline at what volume in the first minutes?

• A. 100-200 mL isotonic saline
• B. 1-2 L isotonic saline
• C. 0.5 L isotonic saline
• D. 5-10 L isotonic saline

Answer: (B)

In adults experiencing anaphylaxis, the body’s reaction leads to widespread vasodilation and increased capillary permeability, which drops the effective circulating volume and can cause shock. The fluid resuscitation goal is to quickly restore preload and improve perfusion while epinephrine addresses the underlying mediator release.

Therefore, a rapid bolus of 0.9% isotonic saline is given, typically about 1–2 liters in the first minutes, with reassessment after each bolus. This range is large enough to counteract the hypotension without overloading the circulation. The other options are either too small to make a meaningful impact on hemodynamics or too large, raising the risk of fluid overload. Fluids accompany epinephrine—not a substitute for it—and should be tailored to the patient’s response and tolerance, with careful monitoring for signs of fluid overload.