Fluid and electrolyte overload in critically ill patients: An overview Bruno Adler Maccagnan Pinheiro Besen, André Luiz Nunes Gobatto, Lívia Maria Garcia Melro, Alexandre Toledo Maciel, Marcelo Park Bruno Adler Maccagnan Pinheiro Besen, André Luiz Nunes Gobatto, Lívia Maria Garcia Melro, Alexandre Toledo Maciel, Marcelo Park, Intensive Care Unit, Department of Medical Emergencies, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo 05403000, Brazil André Luiz Nunes Gobatto, Alexandre Toledo Maciel, Imed Research Group, Intensive Care Unit, Hospital Sao Camilo Pompéia, Sao Paulo 05022-001 Brazil Author contributions: Besen BAMP, Gobatto ALN, Melro LMG, Maciel AT and Park M all contributed to this paper and fulill all authorship credits in accordance with the ICMJE guidelines. Conlict-of-interest: The authors have no conlicts of interest to declare. Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/ licenses/by-nc/4.0/ Correspondence to: Bruno Adler Maccagnan Pinheiro Besen, MD, Intensive Care Unit, Department of Medical Emergencies, Hospital das Clínicas, University of Sao Paulo Medical School, Carvalho Aguiar street, 255, 6 th Floor, Room 6040, Sao Paulo 05403000, Brazil. brunobesen@yahoo.com.br Telephone: +55-11-26616457 Received: September 29, 2014 Peer-review started: October 2, 2014 First decision: November 14, 2014 Revised: December 24, 2014 Accepted: March 4, 2015 Article in press: March 5, 2015 Published online: May 4, 2015 Abstract Fluids are considered the cornerstone of therapy for many shock states, particularly states that are associated with relative or absolute hypovolemia. Fluids are also commonly used for many other purposes, such as renal protection from endogenous and exogenous substances, for the safe dilution of medications and as “maintenance” fluids. However, a large amount of evidence from the last decade has shown that fluids can have deleterious effects on several organ functions, both from excessive amounts of fluids and from their non-physiological electrolyte composition. Additionally, luid prescription is more common in patients with systemic inflammatory response syndrome whose kidneys may have impaired mechanisms of electrolyte and free water excretion. These processes have been studied as separate entities (hypernatremia, hyperchloremic acidosis and progressive luid accumulation) leading to worse outcomes in many clinical scenarios, including but not limited to acute kidney injury, worsening respiratory function, higher mortality and higher hospital and intensive care unit length- of-stays. In this review, we synthesize this evidence and describe this phenomenon as fluid and electrolyte overload with potentially deleterious effects. Finally, we propose a strategy to safely use fluids and thereafter wean patients from luids, along with other caveats to be considered when dealing with luids in the intensive care unit. Key words: Fluid therapy; Critically Ill; Oliguria; Water- electrolyte balance; Central venous pressure; Resuscitation; Acute kidney injury; Diuretics; Multiple organ dysfunction syndrome; Systemic inlammatory response syndrome © The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved. Core tip: Fluids are a cornerstone of the management of critically ill patients with systemic inlammatory response syndrome who are at risk of multiple organ dysfunction syndrome. However, as with any therapy, fluids can be associated with harm, such as added or worsening organ dysfunctions. Therefore, patients should be weaned from fluids when possible, sometimes through an active de- resuscitation strategy. REVIEW World Journal of Critical Care Medicine W JC C M Submit a Manuscript: http://www.wjgnet.com/esps/ Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx DOI: 10.5492/wjccm.v4.i2.116 World J Crit Care Med 2015 May 4; 4(2): 116-129 ISSN 2220-3141 (online) © 2015 Baishideng Publishing Group Inc. All rights reserved. May 4, 2015|Volume 4|Issue 2| WJCCM|www.wjgnet.com 116