I. Elderly Patient with Excessive Fluid Administration Leading to Heart Failure

I. Elderly Patient with Excessive Fluid Administration Leading to Heart Failure

We were invited to consult at Lanzhou Railway Central Hospital. The patient was an 82-year-old woman, the mother of Wei Shiguang, Secretary of the Party Committee of Qilihe District, Lanzhou City. One week prior, after undergoing emergency cholecystectomy for acute cholecystitis, the patient began experiencing abdominal distension three days later, with a continuous trickle of fluid at the incision site. The attending physician performed a fluid analysis, which revealed transudate; her body temperature was not elevated, her blood count was normal, and infectious factors were ruled out. Liver function was normal, the spleen was not enlarged, and liver cirrhosis was excluded. The attending physician reported the case to the department director and the hospital president, but it was still difficult to reach a definitive diagnosis. For this reason, we were specially invited to visit the hospital for consultation. Upon examination, we noted a deep, fine pulse with irregular rhythms; auscultation revealed a diminished first heart sound in the precordial region, along with multiple premature beats. When asked about the patient's condition, we learned that she had been receiving approximately 2500 ml of fluids daily post-surgery, with no restrictions on infusion rate—up to 80 drops per minute—and fine crackles were heard at the lung bases upon auscultation. The patient complained of palpitations, shortness of breath, chest tightness, and occasional coughing and wheezing. Her abdomen was markedly distended, with the liver located 8 cm below the xiphoid process and 3 cm below the costal margin; ascites was strongly positive, along with lower limb edema and jugular vein distension. We diagnosed heart failure. We instructed her to reduce the fluid infusion rate and slow down the infusion speed, prescribing digoxin 0.25 mg twice daily, orally; traditional Chinese medicine: Codonopsis 10 g, Atractylodes macrocephala 10 g, Poria 12 g, dried grass 6 g, Cinnamomum cassia 10 g, dried cinnamon bark 6 g, White Peony 10 g, Dried Ginger 6 g, Ophiopogon 10 g, Schisandra 6 g, decocted in water and taken once daily. Western medicine was limited to administering Bactrim in 250 ml of saline solution, slowly infused intravenously (less than 30 drops per minute). Three days later, the patient’s ascites and edema had completely resolved, her mental state improved, and symptoms such as chest tightness, palpitations, and shortness of breath had disappeared entirely. After the surgical sutures were removed, the patient was discharged. Following the consultation and accurate diagnosis, the patient took appropriate measures and recovered within just three days. The elderly patient had endured surgical trauma and underwent a week-long course of extensive fluid administration, with infusion rates reaching 80–90 drops per minute—too much strain on the heart, which soon led to heart failure. Crackles at the lung bases, chest tightness, shortness of breath, and palpitations indicated left ventricular failure; hepatomegaly, ascites, lower limb edema, and jugular vein distension suggested right ventricular failure. Arrhythmias were also clinical manifestations of cardiac dysfunction.