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Albumin supplementation during the first week after a burn does not mobilise tissue oedema in humans
H J Zdolsek1, B Lisander, A W Jones
1Department of Anaesthesiology, University Hospital, Linköping, Sweden. joachim.zdolsek@lio.se
Objective:
To measure water balance and changes in distribution, and the effect of giving supplementary albumin, early after a burn injury.
Design:
Consecutive patients (matched groups) and healthy controls.
Setting:
National burn unit in a Swedish university hospital.
Patients And Subjects:
Eighteen patients with 18%-90% total burned surface area and 16 healthy male control subjects.
Interventions:
The patients were given an intravenous infusion of ethanol over 1 h, 0.35-0.60 g/kg body weight, and a bolus of 3.3 to 6.5 g of iohexol. The control subjects were given the same amounts of either ethanol or iohexol. Patients were subdivided into two groups according to whether or not they received supplementary albumin starting 12 h post-burn.
Measurements And Results:
Blood samples were drawn at 20-30 min intervals over 4 h after the start of the infusion. Serum ethanol was measured by headspace gas chromatography, and iohexol with high-pressure liquid chromatography (HPLC). Distribution volume was calculated from the concentration-time profiles. Total body water (TBW) was measured by the ethanol tracer and bioelectric impedance (BIA) techniques, and estimated extracellular water (ECWest) by iohexol tracer. They were all significantly increased after a burn. Excess water was accumulated mainly in the extracellular compartment. It declined towards normal values (those of volunteers) at the end of the week. Albumin supplementation did not influence the amount or distribution of the excess fluid.
Conclusion:
Body water increases after a burn. Excess water is mainly deposited in the extracellular space. Tissue oedema fluid is not mobilised by albumin supplementation.