Burn Resuscitation with Two Doses of 4 mL/kg Hypertonic Saline Dextran Provides Sustained Fluid Sparing: A 48-Hour Prospective Study in Conscious Sheep

BACKGROUNDThe large fluid volumes usually required for burn resuscitation can be suppressed for 8 to 12 hours by intravenous infusion of 4 mL·kg hypertonic saline dextran (HSD) 1 hour after burn. We hypothesized that a double (8 mL·kg) dose of HSD or two repeated doses of 4 mL·kg could enhance or prolong the volume sparing. METHODSWe produced a full-thickness flame burn covering 40% of the body surface on 18 anesthetized sheep. One hour after the burn, the animals were awake and resuscitated with either (1) lactated Ringer’s solution (LR) only, (2) 8 mL·kg HSD followed by LR, or (3) 4 mL·kg HSD followed by LR, with a second dose of 4 mL·kg HSD administered when net fluid accumulation increased to 20 mL·kg. For all regimens, infusion rates were adjusted to produce a urine output of 1 to 2 mL·kg·h. RESULTSAnimals resuscitated with only LR required fluid volumes identical to that predicted by the Parkland formula for the first 12 hours. Infusion of 8 mL·kg HSD initially created a net fluid loss (urine output > infused volume), followed by a rebound fluid requirement eventually equaling that of animals treated with LR only. Animals treated with two separate doses of 4 mL·kg HSD generally did not experience a net fluid loss or a rebound fluid requirement. Also in the HSD×2 group, peak and net fluid accumulation was less than that of the other two groups from 18 hours through 48 hours, although the difference was not significant. CONCLUSIONAn initial 4 mL·kg dose of HSD reduces fluid requirements early after burn, and a second dose administered after an appropriate interval may prolong volume sparing through 48 hours. An 8 mL·kg continuously infused initial dose was without prolonged fluid sparing effect. The volume-sparing effect of HSD is thus dependent on all of the followingdose, dosing interval, and infusion rate.