The effects of resuscitation with hypertonic vs. hypotonic vs. colloid on wound and urine fluid and electrolyte losses in severely burned children.

Thirty-nine children with large burns were resuscitated with either a hypertonic (HLS) (17 patients), hypotonic (11 patients), or colloid (11 patients) fluid regimen. Burn dressings, bed linen, and urine were analyzed for electrolyte content. The group receiving HLS excreted the greatest percentage of the administered sodium load in the urine, significantly more than the other two groups; however, the combined wound and urinary sodium losses were significantly greater for the group receiving colloid. Sodium loss through the burn wound exceeded urinary loss fivefold in the colloid group. The volume of fluid lost across the burn wound was inversely related to the osmolality of the fluid used for resuscitation. Wound sodium loss was a function of both sodium and fluid load. The flux of fluid and electrolytes across the burn wound is a dynamic part of the resuscitation problem and is dramatically effected by the volume and concentration of fluid used.