Ideal burn resuscitation: a step toward resolving the dilemma in acute flame burn management

Following severe burns, the predominant concern is significant fluid loss, for which balanced crystalloid solutions are widely recommended as the primary intravenous resuscitation fluids. However, current literature lacks a clear distinction among various buffered crystalloid types that might be most effective in the early resuscitation of burn patients. This retrospective study was conducted to identify the optimal resuscitation fluid for major burns and to assess the clinical outcomes associated with isotonic crystalloid solutions compared to hypotonic crystalloids, specifically in terms of urinary output, acid-base balance, and electrolyte stability. Conducted over one year at the Burn Care Center of the Pakistan Institute of Medical Sciences in Islamabad, the study involved 132 patients who were divided equally into two groups, each with 66 patients. Group A received isotonic crystalloids, while Group B was administered hypotonic crystalloids. The mean pre-infusion levels of sodium, potassium, bicarbonate, and pH were identical across both groups. Following infusion, sodium and chloride levels remained within normal ranges in the isotonic group. Among children under 12 years of age, none in the isotonic group exhibited a urine output below 1 ml/kg/h, while 22.7% of those in the hypotonic group had urine output below this threshold. In patients over 12 years, only one individual in the isotonic group presented a urine output of less than 0.5 ml/kg/h, compared to 19.7% of those in the hypotonic group. These findings indicate that isotonic crystalloids are superior to hypotonic crystalloids, demonstrating improved urinary output and better serum electrolyte balance in patients with severe burns.