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Critical evaluation of hypertonic and hypotonic solutions to resuscitate severely burned children: a prospective
Insights
Severely burned children can be safely resuscitated with less water than typically used. Hypertonic lactated saline (HLS) resuscitation in pediatric thermal burns demonstrated efficient fluid management compared to lactated Ringer's solution (LRS).
Area of Science:
- Pediatric critical care
- Burn management
- Fluid resuscitation
Background:
- Large thermal burns (≥30% body surface area) in children necessitate aggressive fluid resuscitation.
- Current fluid resuscitation protocols often involve large volumes of hypotonic solutions, potentially leading to fluid overload.
Purpose of the Study:
- To compare the efficacy and safety of hypertonic lactated saline (HLS) versus lactated Ringer's solution (LRS) for fluid resuscitation in severely burned children.
- To evaluate the impact of different fluid regimens on electrolyte balance, body weight, and overall fluid management.
Main Methods:
- Children with severe thermal burns were randomized to receive either HLS or LRS.
- Comprehensive monitoring included serum/urine electrolytes and osmolalities, blood gases, protein levels, BUN, CBC, blood sugar, body weight changes, and sodium, potassium, and water balance.
- Parameters were sequentially measured up to 48 hours postburn.
Main Results:
- The HLS group received significantly less water (49% at 8h, 44% at 24h, 38% at 48h) compared to the LRS group.
- Despite receiving more sodium, the HLS group showed no difference in sodium balance at 48 hours, retaining less administered sodium (69% vs. 83%).
- Positive water balance was significantly greater in the LRS group throughout the first 48 hours postburn.
Conclusions:
- Current hypotonic fluid resuscitation regimens for pediatric burns may involve excessive water administration.
- Severely burned children can be safely and effectively resuscitated using conventional sodium loads with approximately one-third less water than typically administered.
- HLS may offer a more efficient fluid management strategy in pediatric burn resuscitation.
Abstract:
Children with thermal burns covering 30% or more of the body surface area were alternately resuscitated with either hypertonic lactated saline (HLS) or lactated Ringer's solution (LRS). Parameters sequentially measured and calculated included: 1) serum and urine electrolyte concentrations, 2) serum and urine osmolalities, 3) arterial blood gases, 4) total and fractional serum proteins, 5) blood urea nitrogen, complete blood count and blood sugar concentration, 6) changes in body weight, 7) sodium, potassium and water balance. The water load received by the HLS group was significantly less through 48 hours postburn (49% at 8 hours, 44% at 24 hours and 38% at 48 hours postburn). Although the HLS group received significantly more sodium than the LRS group, there was no difference in sodium balance at 48 hours postburn. This is explained by the fact that the HLS group, at 48 hours postburn, retained significantly less of the administered sodium load (69% vs. 83%). Positive water balance was significantly greater in the LR group for the first 48 hours postburn. This study suggests that current hypotonic fluid regimens for burn resuscitation contain water in excess of that required for proper resuscitation. Severely burned children may be safely and efficiently resuscitated with conventional salt loads and one-third less than usual water loads.