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Fluid therapy in the emergency department: an expert practice review
  1. Tim Harris1,2,
  2. Timothy J Coats3,
  3. Mohammed H Elwan3,4
  1. 1Academic Department Emergency Medicine, Queen Mary University of London, London, UK
  2. 2Barts Health NHS Trust, Leicester, UK
  3. 3Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
  4. 4Department of Emergency Medicine, Alexandria University, Alexandria, Egypt
  1. Correspondence to Dr Mohammed H Elwan, Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 5WW, UK; mohammed.elwan{at}


Intravenous fluid therapy is one of the most common therapeutic interventions performed in the ED and is a long-established treatment. The potential benefits of fluid therapy were initially described by Dr W B O’Shaughnessy in 1831 and first administered to an elderly woman with cholera by Dr Thomas Latta in 1832, with a marked initial clinical response. However, it was not until the end of the 19th century that medicine had gained understanding of infection risk that practice became safer and that the practice gained acceptance. The majority of fluid research has been performed on patients with critical illness, most commonly sepsis as this accounts for around two-thirds of shocked patients treated in the ED. However, there are few data to guide clinicians on fluid therapy choices in the non-critically unwell, by far our largest patient group. In this paper, we will discuss the best evidence and controversies for fluid therapy in medically ill patients.

  • acute care
  • cardiac care
  • intensive care
  • ultrasound
  • resuscitation

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been corrected since it was published Online Firts. Two dates in the abstract have been corrected (1831 and 1832).

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