What intravenous solution should the nurse administer to a client diagnosed with hyperosmolar hyperglycemic state who is severely dehydrated?

In the case of a client diagnosed with hyperosmolar hyperglycemic state (HHS) who is severely dehydrated, the primary goal is to restore intravascular volume and rehydrate the patient effectively. Administering normal saline, which is a 0.9% sodium chloride solution, is highly effective for this purpose.

Normal saline is isotonic, meaning it matches the osmolarity of bodily fluids. This makes it ideal for rapidly expanding the intravascular volume without potentially causing fluid shifts that could occur with hypotonic solutions, such as 0.45% sodium chloride. In HHS, the client is already in a hyperosmolar state, so an isotonic solution helps bring the osmolarity back to a normal range while providing necessary hydration.

Additionally, normal saline also helps with the dilution of serum glucose levels, which is particularly important given the high blood glucose concentrations found in HHS. The restoration of fluid balance is critical in this state to correct electrolyte imbalances and to promote kidney function, as dehydration can significantly impair renal effectiveness.

Other options, while they may have their uses in specific situations, do not provide the same immediate isotonic effect crucial in managing severe dehydration associated with HHS.