Paediatric Burns series: #4

Fluids

Fluid losses are slow and predictable. In the early phase of injury, shock is due to another cause.
 
All fluid formulae

• take no account of other injuries
• are a starting point only
• increase oedema in injured and uninjured tissues

Baxter (parkland) formula: 2-4ml/kg x body weight x %burn

• From time of burn: Half in first 8 hours, remainder in 16 hours. If you are ‘playing catch up’ spread this over 8 hours rather than giving a bolus.
• Note: you may well have estimated the body weight and the %burn, therefore potentially compounding your error

Flame burn patients are likely to be sicker and require more fluids than scald burns.
 
Timing of resuscitation fluid in children: if started within 1hour better survival in major burns (>20%).
Urine output targets: adult 0.5-1ml/kg, children 2ml/kg. May also use lactate to track response. Be prepared to cut back. Beware… children may develop SIADH picture post burn (some opinion that 0.5-1ml/kg/hr if Na/renal function + haemodynamics stable is OK).

Beware fluid creep: just because fluids are good in burns, does not necessarily mean more fluids are better. Consider starting at lower end of 2-4 ml/kg
 
Excess fluids cause: burn progression, non-wound oedema, compartment syndromes, impaired gas exchange, cerebral oedema
 
Remember that fluids are COLD, warm them before infusing.

Clare Bosanko, Febr 2017