The physiology, pathophysiology, and clinical implications of fluid resuscitation in critically ill patients
Eraky, Akram M Mokhtar, Yasser Khan, Adnan Farag, Amr Elawany, Sondos Alsabbagh, Walaa Wright, Alisha Alamrosy, Mostafa
Eraky, Akram M
Mokhtar, Yasser
Khan, Adnan
Farag, Amr
Elawany, Sondos
Alsabbagh, Walaa
Wright, Alisha
Alamrosy, Mostafa
Abstract
One of the most common interventions in the ED and ICU to restore physiologic homeostasis is fluid administration. It is essential for the intensivists and ED physicians to be aware of the physiological characteristics of different fluids and the potential harm associated with their use. In this article, we explore the physiology and pathophysiology of fluid administration in humans, emphasizing how fluid administration can alter acid-base balance, perfusion, osmotic and oncotic pressures, immunologic and inflammatory responses, and hemodynamics. We also discuss fluid resuscitation strategies across common clinical scenarios, such as septic shock, diabetic ketoacidosis, rhabdomyolysis, acute pancreatitis, and acute brain injury. The most recent guidelines, clinical trials, and observational studies on fluid resuscitation were discussed and critically analyzed. We also discussed fluid management in high-risk populations, such as patients with end-stage renal disease or congestive heart failure, who are particularly susceptible to hypervolemia.
MIDER Authors
Date
2026-03-05
Type
Article
Collections
Citation
Eraky AM, Mokhtar Y, Khan A, Farag A, Elawany S, Alsabbagh W, Wright A, Alamrosy M. The Physiology, Pathophysiology, and Clinical Implications of Fluid Resuscitation in Critically Ill Patients. Cureus. 2026 Mar 5;18(3):e104736. doi: 10.7759/cureus.104736
Journal / Source Title
Cureus
DOI
10.7759/cureus.104736
PMID
41943762
Publisher
Cureus
Publisher’s URL
http://www.cureus.com