Bedi MK, Sarabahi S, Agrawal K, et al.
Burns : journal of the International Society for Burn Injuries. Date of publication 2019 Mar 1;volume 45(2):335-340.
1. Burns. 2019 Mar;45(2):335-340. doi: 10.1016/j.burns.2018.03.011. Epub 2019 Jan
25.
New fluid therapy protocol in acute burn from a tertiary burn care centre.
Bedi MK(1), Sarabahi S(2), Agrawal K(2).
Author information:
(1)Department of Burns, Plastic and Maxillofacial Surgery, Vardhaman Mahaveer
Medical College and Safdarjang Hospital, New Delhi, 110 029, India. Electronic
address: siman479@gmail.com.
(2)Department of Burns, Plastic and Maxillofacial Surgery, Vardhaman Mahaveer
Medical College and Safdarjang Hospital, New Delhi, 110 029, India.
BACKGROUND: Ringer lactate is the main fluid for resuscitation of acute burns.
However it is not a complete fluid alone, as it does not take care of sugar and
electrolyte balance adequately. This study has been carried out to compare the
use of Ringer lactate (RL) alone and combination of RL with Dextrose Normal
Saline (DNS) as fluid replacement therapy in acute burn.
OBJECTIVE: To assess the biochemical parameters with the use of DNS as
maintenance fluid in combination with Ringer lactate as resuscitation fluid in
acute burns resuscitation.
METHOD: A prospective randomized control study has been carried out by enrolling
200 patients into 2 groups, treated in ICU and resuscitated by using Modification
of Brooke's formula (2mL/kg/% TBSA for resuscitation plus 2500mL maintenance).
Group A received RL for resuscitation and DNS as maintenance in 1st 72h of burns.
Group B received RL only for 1st 72h. The effects of this on various blood
parameters were studied.
RESULTS: Mean value of sodium at 24h was 137.79±3.89 in group A and was
133.2±4.57 (p<.0001) in group B. The sodium levels remained in range of 137-138
(p<.0001) in group A with only 22% patients showing lower range of sodium levels,
whereas, there was a falling trend (p<.0001) of sodium levels in group B on
subsequent days with 54.00% (p<.0001) showing hyponatremia on 1st day which
increased to 76% on 3rd day. Mean values of early morning random blood sugar
(RBS) levels in group A remained between 165.5±65.51mg/dL-115.82±32.52mg/dL on
all 3days but in group B there was a falling trend from 127.49±46.11mg/dL to
102.84±22.92mg/dL by 3rd day. Thus, there was significant difference in levels of
sodium and RBS in patients receiving DNS as maintenance fluid in addition to RL
in acute phase.
CONCLUSION: RL is not an ideal fluid for maintenance as it is low in sodium
(130mEq/L) as well as potassium (4mEq/L) in view of daily electrolyte
requirement. There is no glucose content in it to provide calories. Therefore,
DNS should be added as daily maintenance fluid with RL as replacement for
evaporative losses following burns.
Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.
DOI: 10.1016/j.burns.2018.03.011
PMID: 30686697
