Sepsis and septic shock persist as major healthcare challenge, with high morbidity and mortality. Fluid management is a large part of the treatment in patients with these disorders. Fluid therapy has been an important component of the care of patients for the past century. However, recently well-designed studies have been published focusing on the impact of the type and amount of fluids on important clinical outcomes. This review summarizes all the relevant recent studies and attempts to develop a rational approach to the initial fluid management of patients with suspected sepsis.