A physiologic approach to fluid therapy in severely burned children.

Fluid balance data in 30 severely burned children hydrated according to a fluid resuscitation program were reviewed. The formula to estimate fluid requirements is based upon body surface area and surface area burned rather than weight. It uses two independent figures to estimate maintenance fluid needs and fluid requirements as a result of the burn. A standard isotonic solution containing 12.5 grams of human serum albumin is used for hydration. The state of hydration is monitored using several clinical and laboratory guides. The use of hourly urine volume for this purpose has been de-emphasized. Although no complications directly related to fluid therapy were encountered, five of the 30 children died as a result of septicemia five, ten, 12, 23 and 37 days postburn, respectively. A maximal weight increase following resuscitation averaged 4 kilograms per square meter of body surface burned. The volumes of urine that can be expected from patients similarly resuscitated have been defined. This program is safe, accurate and effective for a wide range of burn sizes and age groups.