Right fluid, right volume, right time — reassess dynamically.
Crystalloid choice
- • Balanced (PlasmaLyte / Ringer's) preferred over 0.9% NaCl for resuscitation
- • Saline OK for short courses / specific indications
Resuscitation
- • Initial 30 mL/kg in septic shock (over first 3h)
- • Reassess after each 250-500 mL bolus
Maintenance
- • Adult ~25-30 mL/kg/day water
- • 1 mmol/kg/day Na and K
Avoid
- • Excess saline (hyperchloraemic acidosis)
- • Hydroxyethyl starch
- • Over-resuscitation (pulmonary oedema, AKI)
Pearls
- • Passive leg raise / VTi for fluid responsiveness
- • Stop fluid bolus when CVP / lung US shows congestion
Educational support only — follow institutional ICU protocols.
