Which statement about fluid management in acute heart failure is correct?

• A. Normal saline is the first-line IV fluid for all heart failure patients.
• B. Isotonic saline at a high rate is safe and recommended.
• C. Normal saline should be used with diuretic support.
• D. Normal saline may worsen fluid overload and should be avoided.

Answer: (D)

In acute heart failure with congestion, the goal is to reduce excess fluid, not add more. Normal saline increases circulating volume and can raise preload, worsening edema and pulmonary congestion. That’s why it isn’t used routinely in these patients. Instead, management centers on removing excess fluid with diuretics (usually loop diuretics) and using vasodilators or other therapies to relieve congestion when appropriate. You’d only consider fluids at all if there’s clear hypoperfusion or volume depletion, and then only in small, carefully monitored amounts. So the statement that normal saline may worsen fluid overload and should be avoided captures the standard approach.