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Furthermore, we now have data on over 250 patients; the effects and benefits are reproducible time over time, over time again.

As clinicians our primary responsibly is and will always be to do what is right for the patient. I have become acutely aware of the enormous impact and power of the Internet and Social Media to influence behavior and dialogue.

It is noteworthy that in a lawsuit filed in the third District Court of Salt Lake County (Civil Case #140900123) by the Estate of Melvin Richins arising from the death of Mr Richins, a patient with severe sepsis who died of “salt-water drowning”, all the defendants in this case were found guilty of causing the patients’ death by fluid overload. In a more recent case (March 2017) a Fulton County State Court Jury In his opening statement, Attorney Stone used a bucket and a table full of water bottles to highlight his contention that [the Hospitals’] negligent care set in motion an ultimately catastrophic fluid overload.

Walking jurors through [the patients’] treatment records, Stone poured water into a one-gallon bucket each time entries showed that [the patient] was given additional IV fluids, despite notes that she was not urinating enough.

This is not a new concept and was elegantly demonstrated in a series of studies performed at the NIH by Frederick Ognibene, Margaret Parker and colleagues in the late 80’s.

These authors demonstrated that patients in septic shock were unable to increase left ventricular end-diastolic volume (LVEDV) and stroke volume in response to a fluid challenge.[11,12] It is important to emphasize that some patients with sepsis are dehydrated (due to poor oral intake, etc) and may respond to SMALL boluses of fluid.