Fluid therapy in paediatric burn injuries – should the current rules be changed?

Aim of the study
Tissue damage resulting from thermal injury is associated with systemic disturbances of the water-electrolyte balance. This process consists of exudation and increased evaporation within the burnt area. Therefore, appropriate fluid therapy plays a key role in stabilisation of the general condition and treatment of burns. It is even more important in children with burns. It should be verified whether the existing fluid therapy rules require modification. This is the purpose of the study.

Material and methods
An analysis was performed on hospitalisation of 310 children with isolated burn injury. Hydration rate, followed by electrolyte balance and acid-base balance, were evaluated. Fluid balance and everyday body weight were recorded. The obtained data were analysed using the descriptive statistical methods and tools.

Results
In the group of patients treated according to the Parkland formula, a significant overhydration rate was observed. Overhydration at admission to hospital was recorded in 42.6% of patients, and after 24 hours of hospitalisation in 59.8% of children. Children with burn injuries covering up to 20% of total body surface area (TBSA) required no additional fluid supplementation exceeding the daily fluid intake in order to maintain normal hydration as well as electrolyte and acid-base balances. The sodium bicarbonate solution was not necessary to achieve correction of acid-base balance at the first stage of burn disease management.

Conclusions
Application of technologically advanced dressings results in reduced local fluid escape, which is associated with increased risk of patient overhydration and necessary modification of the commonly applied principles of fluid therapy. Children with burn injuries covering up to 20% of TBSA do not require supplementation of any other fluids than crystalloids, in particular supplementation with sodium hydrogen carbonate solution in order to maintain the correct value of the water-electrolyte and acid-base balance.