Doc, you described the fluid requirement in the first 24 hrs, what
happens in the next 24 hrs? How do we calculate the fluid requirements for
that?
One more question- you gave a few formulas for the burn calculation,
could you outline some more?
Surya, N Delhi, India
The formula for fluid resuscitation
help to calculate the fluid requirements for the first 24 hours. It is during
this period that the critical fluid displacements and loss occur. Loss of body
fluids from the burn surface area as well as the leaking of intravascular
fluids into the extracellular spaces account for the fluid loss that occur in
burn patients. However the body regains its capacity to maintain its intravascular
volume by avoiding the leaking of plasma proteins and in fact by the 2nd
24 hours after the burn, the fluids from the extra vascular spaces start
getting reabsorbed. Therefore at this stage it is not necessary to administer a
lot of fluids as we do in the first 24 hours. During the second 24 hours the
fluids are calculated from the normal daily requirements as any surgical
patient and additional fluids are given to maintain the clinical parameters
like the pulse, blood pressure and urine output (half ml/kg/hr in adults and
one ml/kg/hr in children) as outlined in a previous post.
Some formulas advice cutting down the
fluids to be administered in the 2nd 24 hours to half that of the
first 24 hours. This again is a guideline and one must not forget that the
resuscitation process is a continuous process and no sudden changes must be
attempted in fluid administered which must be very gradually reduced depending
on the clinical parameters and patient response unless the patient is in shock
or with volume overload.
The parkland formula has been
described before in detail. Some of the other resuscitation formulas which were
not mentioned in our previous articles are outlined below:
Resuscitation Formulas in burn patients
|
Formula
|
Fluid
in First 24 Hours
|
Crystalloid in 2nd 24-Hours
|
Colloid in 2nd 24-Hours
|
|
Brooke (Yowler, 2000)
|
RL at 1.5 mL/kg per percentage burn, colloid at 0.5 mL/kg
per percentage burn,
- add 2000 mL D5W
|
50% of first 24-hour volume -
add
2000 mL D5W
|
50% of first 24-hour volume
|
|
Modified Brooke
|
RL at 2 mL/kg per percentage burn
|
|
|
|
Evans (Yowler, 2000)
|
NS at 1 mL/kg per percentage
burn, 2000 mL D5W*, and colloid at 1 mL/kg per percentage burn
|
50% of first 24-hour volume and add 2000 mL D5W
|
50% of first 24-hour volume
|
|
Monafo hypertonic
Demling |
250 mEq/L saline titrated to urine output at 30 mL/h,
dextran 40 in NS at 2 mL/kg/h for 8 hours, RL titrated to urine output at 30
mL/h, and fresh frozen plasma 0.5 mL/h for 18 hours beginning 8 hours post
burn
|
One-third NS titrated to urine output
|
|
|
Metro Health
(Cleveland) |
RL solution with 50 mEq sodium bicarbonate per liter at 4
mL/kg per percentage burn
|
Half NS titrated to urine output
|
1 U fresh frozen plasma for each liter of half NS used
and add
D5W as needed for
hypoglycemia
|
|
Slater (Yowler, 2000)
|
RL at 2 L/24 h and
add fresh frozen plasma at 75 mL/kg/24
h
|
|
|
*D5W is
dextrose 5% with water
(An original initiative in burn care and education from asktheburnsurgeon++)+