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Fluid therapy: for burns

ISSN 2398-2950

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Pathophysiology

  • Severe burn   →   significant increase in vascular endothelium permeability throughout the body due to release of inflammatory mediators from burn site.
  • Loss of plasma proteins from vascular space results in reduced plasma oncotic pressure and fluid shift from vascular space to interstitium.
  • As much as 50% of plasma water may be lost from the circulation 2 hours after severe burn injury.
  • Hyperkalemia may result from K+ release from damaged cells.
  • Destruction of red blood cells occurs in the post-burn period because of increased fragility and morphological changes.
  • Metabolic acidosis is common following severe burns.

Treatment

  • Generally avoid colloids or plasma in the immediate post-burn period as they will be lost from the circulation to the interstitium.
  • It is very difficult to estimate fluid deficit. Therefore give Hartmann's solution intravenously and vary rate according to response.
  • If the cat has life-threatening shock   Shock  then it may benefit from rapid infusion of a crystalloid/colloid or crystalloid/hypertonic saline mixture.
  • Monitor serum potassium   Blood biochemistry: potassium  at least daily following severe burns. Hypokalemia may occur a day or two into the post-burn period because of increased renal excretion.
  • Monitor total protein   Blood biochemistry: total protein  and PCV   Hematology: packed cell volume  . Colloids or blood products may be required from 2 days post-burn.
  • If available, monitor blood gases and supplement bicarbonate   Sodium bicarbonate  if pH<7.1. In the absence of this facility, it may be beneficial to add 5 mEq/l bicarbonate to fluids for patients with severe burns.
  • Monitoring central venous pressure   Central venous pressure   and urine output provides a good guide as to the adequacy of the fluid therapy.

Further Reading

Publications

Refereed papers

Other sources of information

  • Saxon W D and Kirby R (1992) Treatment of acute burn injury and smoke inhalation. In: Kirk's Current Veterinary Therapy XI. Eds: R W Kirk and J D Bongura. Philadelphia: W B Saunders. pp 146-153. ISBN 0 7216 3293 9.