Burn resuscitation with two doses of 4 mL/kg hypertonic saline dextran provides sustained fluid sparing: A 48-hour prospective study in conscious sheep

Background: The large fluid volumes usually required for burn resuscitation can be suppressed for 8 to 12 hours by intravenous infusion of 4 mL.kg(-1) hypertonic saline dextran (HSD) 1 hour after burn. We hypothesized that a double (8 mL.kg(-1)) dose of HSD or two repeated doses of 4 mL.kg(-1) could enhance or prolong the volume sparing. Methods: We produced a full-thickness flame burn covering 40% of the body s urface 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(-1) HSD followed by LR, or (3) 4 mL.kg(-1) HSD followed by LR , with a second dose of 4 mL.kg(-1) HSD administered when net fluid accumul ation increased to 20 mL.kg(-1). For all regimens, infusion rates were adju sted to produce a urine output of 1 to 2 mL.kg(-1).h(-1). Results: Animals 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(-1) HSD initially created a net fluid loss (urine output > infu sed volume), followed by a rebound fluid requirement eventually equaling th at of animals treated with LR only. Animals treated with two separate doses of 4 mL.kg(-1) HSD generally did not experience a net fluid loss or a rebo und fluid requirement. Also in the HSDx2 group, peak and net fluid accumula tion was less than that of the other two groups from 18 hours through 48 ho urs, although the difference was not significant. Conclusion: An initial 4 mL.kg(-1) dose of HSD reduces fluid requirements e arly after burn, and a second dose administered after an appropriate interv al may prolong volume sparing through 48 hours. An 8 mL.kg(-1) continuously infused initial dose was without prolonged fluid sparing effect, The volum e-sparing effect of HSD is thus dependent on all of the following: dose, do sing interval, and infusion rate.