When fluid replacement is necessary during hemodialysis, which solution is used?

• A. Lactated Ringer's
• B. 0.9% normal saline
• C. 5% dextrose
• D. Ringer's solution

Answer: (B)

When fluid replacement is needed during hemodialysis, a solution that is isotonic to blood plasma is used to quickly restore intravascular volume without shifting water between compartments. The best choice is 0.9% normal saline because it provides sodium and chloride to raise circulating volume while staying in the extracellular space, helping maintain blood pressure during ultrafiltration.

Lactated Ringer's contains lactate and other electrolytes (including potassium and calcium), which can complicate electrolyte and acid-base management in a dialysis patient. Ringer's solution is similar but also brings extra ions that aren’t ideal during dialysis. A solution with dextrose (5% dextrose) is not used for fluid replacement in this setting because it is not intended for rapid intravascular volume expansion and can cause glucose-related metabolic effects.