PurposeTo review the rationale for adenosine triphosphate-magnesium chloride (ATP-MgCl2) administration in shock, ischemia, and sepsis; the beneficial effects on cellular and organ functions and survival; and possible mechanisms of these effects.Data SourcesCurrent literature review.Study SelectionArticles deemed most pertinent, current, and representative were utilized.Data SynthesisDespite apparent, adequate resuscitation of hypovolemic shock and sepsis in experimental animals and patients, persistent cellular and organ dysfunction is apparent. Disturbances in organ microcirculation and tissue hypoxia appear to play an important role. These disturbances occur when the energy needs are increased. Because of the theoretical benefits of ATP-MgCl2as an energy source, as well as a vasodilator, the administration of ATP-MgCl2has been investigated extensively, and considerable evidence suggests that ATP-MgCl2restores the depressed cell and organ functions following ischemia, hypovolemic shock, and sepsis.ConclusionsATP-MgCl2improves cellular and organ function and survival following experimental shock, ischemia, and sepsis. Studies also indicate that ATP-MgCl2can be administered safely in experimental animals and in normal human volunteers, as well as in patients following various adverse circulatory conditions. Further trials should be undertaken to determine the effects on cell and organ function in patients following traumatic shock and sepsis.