Our experience in the treatment of burn shock by hypertonic lactated saline solution

Hypertonic salt solutions have for many years been known to be effective in the treatment of burn shock. Rapid infusion of a high concentration of sodium (250 mEq/l) produces positive effects by reducing fluid shifts, decreasing tissue oedema, and causing fewer attendant complications. This study presents data on 20 patients with severe burns who were resuscitated with hypertonic lactated saline (HLS) solution. The resuscitation regime used was that proposed in the USA and subsequently also in Europe. The fluid formula is based only on calculating fluid requirements for the first hour of therapy. Further adjustments of fluid requirements are based mainly on urine output. During the first hour of fluid therapy the amount of HLS given (ml) is 0.5 x percentage TBSA x kg body weight. This regime is recommended for resuscitation both of children, taking into consideration that urine output should be 1 ml/kg body weight/h, and of adults and the elderly, in whom an amount of 35 ml of urine per h is considered optimal and reflects sufficient vital organ perfusion. In order to control the administration of fluid volumes, we calculated fluid and sodium balances. Fluid load was 2.3 ml/kg/%; sodium load, 0.6 mEq/kg/%; net fluid accumulation, 20-30 ml/kg; and sodium retention, 56 %, associated with high natriuresis. We observed a high volume load in the first hour and in the first four hours of therapy, which regressed after lower fluid loads. During resuscitation the clinical and laboratory criteria were maintained within acceptable limits. Our clinical experience indicates that during burn shock resuscitation with HLS solution, the amount of fluid can be reduced, compared to conventional formula. Early administration of high sodium and fluid loads in the first four hours may decrease the total fluid load in the first 24 hours post-burn. A hypertonic regime requires careful observation and calculations. Resuscitation with HLS solution is a valuable regime in the treatment of severe burn patients that is also applicable in other similar clinical conditions.