In addition, we expand on the concept of the “four D’s” of fluid therapy, namely drug, dosing, duration and de-escalation. In this paradigm-shifting review, we discuss different fluid management strategies including early adequate goal-directed fluid management, late conservative fluid management and late goal-directed fluid removal. ![]() There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications and for parenteral nutrition. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. ![]() In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge.
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