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Use 20 ml/kg crystalloid as an initial bolus of fluids over 30 minutes whilst looking for haemodynamic improvement. Hypovolaemia is demonstrated when elevation of the legs transiently improves blood pressure. Recording of accurate fluid balance is essential.

Fluid balance is difficult in septic shock, as there will be an inevitable tendency of fluid to leak into the lungs as a result of increased capillary permeability, myocardial dysfunction, renal impairment and a low plasma oncotic pressure. If there is no improvement in the blood pressure following the fluid bolus, critical care referral is required.