What is the initial fluid bolus dose for suspected sepsis?

• A. NS or LR bolus 500 mL IV/IO, reassess criteria and re-examine. May repeat x3 for SBP <90, with no rales on lung exam. Max dose 2000 mL
• B. 250 mL
• C. 750 mL
• D. 1000 mL

Answer: (A)

In suspected sepsis, fluids are started in moderate, titratable steps using 500 mL boluses of isotonic crystalloid (normal saline or lactated Ringer’s) given IV or IO, with reassessment after each dose. This approach lets you quickly evaluate how the patient responds and adjust without overloading the circulation. If the patient’s systolic blood pressure remains under 90 mmHg and there are no signs of fluid overload such as rales on lung exam, you may repeat the 500 mL bolus up to three times, for a total maximum of 2000 mL. If rales are present, that indicates possible pulmonary edema, and further fluid boluses should be avoided. The key is to balance restoring perfusion with careful monitoring and timely reassessment after each increment.