Fluid therapy

Large amounts of intravenous fluid need to be given, usually much greater than expected from the size of the cutaneous burn. Peripheral veins may be thrombosed.

Ringer's lactate, Hartmann's solution, or saline are recommended resuscitation fluids. Luceand G.otíli,eb..í1984), suggest 7 ml/kg per percentage of body surface area burned every 24 h. However, many centers prefer to resuscitate initially with colloid solutions and administer fluid guided by filling pressures, best stroke volume, and evidence of adequate tissue perfusion rather than according to formula. Common targets are pulse rate below 120 beats/min, mean arterial pressure above 60 mmHg, SaO2 > 95 per cent, urine output between 0.5 and 1.0 ml/kg/h, base deficit less than 3 mmol/l, a difference of less than 5 °C between core and peripheral temperature, and mixed venous oxygen saturation above 60 per cent. Frequent measurement of electrolytes, hemoglobin, coagulation status, creatinine phosphokinase, and arterial blood gases is essential and standard in the critical care environment.

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