What defines the best fluid management plan for a patient with severe dehydration?

The best fluid management plan for a patient with severe dehydration is to administer IV normal saline boluses until stabilized. This approach is critical because, in cases of severe dehydration, rapid restoration of intravascular volume is essential to prevent complications such as shock or organ failure. Normal saline, being isotonic, effectively helps in re-establishing the necessary fluid balance in the body.

In situations where a patient is severely dehydrated, oral rehydration solutions may not be adequate or feasible, especially in cases where the patient is not able to drink or has ongoing losses (e.g., vomiting, diarrhea). IV administration allows for immediate and controlled fluid replacement, addressing the patient's needs quickly and effectively.

Other options, like giving oral rehydration solution exclusively or using only oral rehydration after one hour, may not provide the immediate response required for severe dehydration. Starting continuous IV dextrose only lacks the necessary electrolyte replenishment that normal saline offers, making it insufficient as a standalone treatment in these circumstances. Thus, the administration of IV normal saline boluses is the most appropriate action to stabilize a patient with severe dehydration.