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Fluid requirements of severely burned children up to 3 years old: hypertonic lactated saline vs. Ringer's
B H Bowser-Wallace1, F T Caldwell
1University of Arkansas Medical Sciences Campus, Department of Surgery.
Insights
Pediatric burn patients under 3 years old need more fluids and sodium, especially when using body weight for calculations. Using body surface area normalizes these needs, but hypertonic lactated saline (HLS) reduces fluid requirements.
Area of Science:
- Pediatric critical care
- Burn management
- Fluid resuscitation
Background:
- Severe burns in children necessitate careful fluid resuscitation to prevent complications.
- Age-related differences in fluid and electrolyte requirements are critical in pediatric burn care.
- Current fluid resuscitation protocols require evaluation for age-specific adjustments.
Purpose of the Study:
- To compare fluid and sodium resuscitation needs in pediatric burn patients based on age.
- To investigate the impact of indexing fluid calculations by body weight versus body surface area.
- To assess the efficacy of hypertonic lactated saline (HLS) compared to Ringer's lactate-colloid.
Main Methods:
- Prospective study of pediatric burn patients (>=30% body surface area) randomized to HLS or Ringer's lactate-colloid.
- Patients stratified into two age groups: <=3 years and >3 years.
- Fluid and sodium intake/output meticulously monitored and analyzed using body weight and body surface area indexing.
Main Results:
- Children <=3 years required significantly more fluid and sodium (body weight indexing) in the first 48 hours.
- No significant age-related differences in fluid/sodium needs when indexed by body surface area, suggesting surface area-to-mass ratio influence.
- HLS group required 23% less fluid in the first 24 hours compared to the Ringer's lactate-colloid group.
Conclusions:
- Clinicians must consider age-specific fluid requirements, particularly when using body weight for estimations in pediatric burn patients.
- Body surface area indexing may provide a more consistent measure of fluid needs across pediatric age groups.
- HLS demonstrates potential for reduced fluid administration in the initial 24 hours of burn resuscitation.
Abstract:
Children with burns greater than or equal to 30 per cent of the body surface area were entered into a prospective fluid resuscitation protocol using hypertonic lactated saline (HLS) or Ringer's lactate-colloid. The two resuscitation groups were subdivided into patients less than or equal to 3 years old and children greater than 3 years old. The children under 3 years old required significantly more fluid and sodium during the first 48 h when calculations were made using body weight as the indexing factor. When fluid and sodium needs of paediatric age groups were calculated using body surface area as the indexing factor, significant differences in fluid and sodium requirements were no longer present between age groups. This suggests that these observed differences may reflect the difference in surface area to mass ratio for these age groups. Children resuscitated with HLS require 23 per cent less fluid in the first 24 h. If body weight is used for estimating fluid needs, clinicians should be aware of the differences in fluid requirements for children less than or equal to 3 years old compared with older paediatric patients. Formulas for estimating fluid needs are presented.