In fluid overload with rising filling pressures, what is a common management step?

• A. Increase fluids
• B. Start vasopressor
• C. Consider diuresis
• D. Initiate dialysis

Answer: (C)

When fluid overload leads to higher filling pressures, the goal is to remove excess volume and ease the heart’s workload. Diuresis achieves this by increasing urine output, which lowers preload and reduces filling pressures, helping to relieve edema and congestion. Loop diuretics act quickly to mobilize fluid and are typically the first-line choice for this scenario, with careful monitoring of urine output, kidney function, and electrolytes. Starting a vasopressor would raise vascular tone and can worsen renal perfusion and fluid balance, while simply increasing fluids would worsen the overload. Dialysis is considered if diuresis is ineffective or the patient has severe kidney failure requiring rapid fluid removal.