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Three major indications exist for intravenous fluid administration : resuscitation, replacement, and maintenance. Intravenous fluids have been in clinical use for over a century, yet the medical and scientific community have only recently begun to appreciate the importance of judicious fluid administration, the necessity to handle them as any other drug we prescribe, and the considerable side effects with which they may be associated. Even in specific categories of critically ill patients, i.e., with trauma or burns, fluid therapy should be carefully applied, considering the importance of their specific aims maintaining peripheral oxygen delivery, while avoiding the consequences of fluid overload. conceptual model (Resuscitation, Optimization, Stabilization, Evacuation) summarizes accurately a dynamic approach to fluid therapy, maximizing benefits and minimizing harms. Active de-escalation protocols may be necessary in a later phase. A similar approach should be considered also for critically ill patients, in whom increased endothelial permeability makes this strategy more relevant. Protocols including a restrictive continuous fluid administration alongside bolus administration to achieve hemodynamic targets have been proposed.

In the perioperative setting, appropriate fluid management that maintains adequate organ perfusion while limiting fluid administration should represent the standard of care. The last decade has seen growing interest in the potential harms related to fluid overloading. Among colloids, albumin, the only available natural colloid, may have beneficial effects. Among crystalloids, balanced solutions limit acid–base alterations and chloride load and should be preferred, as this likely prevents renal dysfunction.

As for antibiotics, intravenous fluid administration should follow the four Ds: drug, dosing, duration, de-escalation. Moreover, the impact of fluid administration as drug diluent or to preserve catheter patency, i.e., fluid creep, should also be considered. There are three main indications: resuscitation, replacement, and maintenance. Intravenous fluid administration should be considered as any other pharmacological prescription.