Fluid management

• The extent of injury will have been estimated by plastic surgeons who will also determine the proportion of full thickness dermal injury to calculate the approximate fluid resuscitation required.

• Fluid resuscitation in the UK often follows the Mount Vernon (albumin-based) formula while the Parkland (crystalloid-based) formula is often used in the US. Colloids may reduce oedema at non-burn sites and restore blood volume faster than crystalloids.

• These formulae only provide an approximate guide and frequently underestimate losses both into the interstitial spaces and through the lost skin barrier. Evaporative losses are approximately 2ml/kg/h. Water losses may be increased if wounds are not covered. Losses increase further with inhalation injury.

• Overzealous fluid infusion should be avoided to minimise oedema.

• The increased permeability and fluid leak phase lasts approximately 1-2 days. After 2-5 days, a diuretic phase usually commences when excess tissue fluid is lost and the body swelling reduces.

• Electrolyte levels (especially K+ and Mg2+) can fluctuate widely in both periods requiring monitoring and replacement as necessary.

• Though some haemolysis may occur, blood transfusion requirements are usually low, but debridement will result in major blood loss often requiring major transfusion (>8-10 units). A coagulopathy will often occur, in part due to a dilutional effect of the albumin infusion.


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