Lightning rounds 67: IV fluids

Clinical management of IV fluids in critical care has shifted from routine maintenance toward intentional, goal-directed administration. Resuscitation requires rapid boluses—often utilizing pressure bags—rather than slow, continuous infusions, which frequently fail to achieve intravascular volume goals. While balanced solutions like Lactated Ringer’s are generally preferred over normal saline, the specific choice often matters less than avoiding excessive volume and iatrogenic harm. Clinical judgment and patient-specific factors, such as the presence of renal failure or intracranial pressure concerns, remain more reliable than single data points like urine output or ultrasound findings. Ultimately, the most effective strategy involves a minimalist approach: prioritize enteral hydration when possible, avoid unnecessary continuous drips, and ensure every fluid intervention is driven by a clear, specific clinical objective rather than habit.