I read with interest the letter responding to my editorial in CHEST (November 2003).1The author argued that fluid overload is a basic problem in the development of nosocomial infections and/or ARDS. Although fluid overload is a consequence of ARDS and its management is probably crucial to the outcome in these patients, to my knowledge, there is no study in the literature supporting fluid overload as an etiology of ARDS apart from near-drowning. Regarding the issue of infection, Rivers et al2proved the opposite, namely, that fluid management is pivotal to the survival of patients presenting with severe sepsis and septic shock. Though conducted in non-critically ill patients, a small review of the literature3 tried to address the issue raised in our correspondence. Guppy and coworkers3 could not, however, identify any serious adverse effects of drinking large quantities of fluid during an acute respiratory infection. Nevertheless, in terms of citable evidence this issue remains unsolved. From my clinical perspective, there is no good reason to assume that parenteral fluid overload induces ARDS or facilitates nosocomial infections. It does, as we are all aware of, often induce problems in patients with left heart failure, and fluid supplementation needs to be closely monitored in all our patients.