58.5 What kinds of fluid does a severely burnt patient need?

A severely burnt patient needs fluid for two purposes, and for each of them the fluid must be different.

(1) A patient needs fluid to replace his fluid loss and treat shock. Besides losing water, he loses sodium from his extracellular fluid into the cells of the unburnt part of his body, so that his plasma sodium falls and must be replaced. If you replace this fluid with plain water, or 5% dextrose intravenously, he may become confused and die from water intoxication (58.10), especially if he is a child, due to excess water and not enough sodium. So, give him Ringer’s lactate or 0.9% saline intravenously. If necessary, you can give him Darrow’s solution.

When you replace a patient’s f luid losses by mouth, give him saline or oral rehydration fluid, or milk not pain water or tea. This is especially important with young children. To make a suitable solution, add a teaspoonful of salt, and another one of sodium bicarbonate, to a litre of water. If you add fruit juice, and serve the mixture cold from the fridge, no child will refuse it.

(2) A patient needs fluids to fulfil his basal (metabolic) water loss. For this he needs water without sodium, so estimate this need from scale E, (his da ily fluid requirements) in Figure 58-6. Give him the water he needs as 5% dextrose intravenously, or as water by mouth.