Fluid Resuscitation: Initial and Reassessment-Driven Strategy

Fluid resuscitation has two different jobs. The initial bolus rapidly supports effective circulating volume during sepsis-related hypoperfusion; the reassessment phase prevents a useful intervention from becoming fluid overload. For an adult with sepsis or septic shock, give at least 30 mL/kg of a balanced crystalloid within the first 3 hours of presentation, or within the first 3 hours of resuscitation, as the initial bolus. Lactated Ringer’s or Plasma-Lyte is preferred to 0.9% saline, particularly when renal impairment increases the risk of hyperchloremic metabolic acidosis and kidney injury. After that initial volume, do not continue by habit. Recheck perfusion and fluid responsiveness. If the patient remains hypoperfused and is likely to benefit, further fluid may be appropriate; if the patient is not fluid responsive or is becoming overloaded, stop repeated boluses and escalate to vasopressor support and an overload-focused plan.