The intravenous fluid that a 60 kg., 30-year-old woman with an 80% burn should be given in the first 24 hours following burn injury is:

B. 14.4 liters of lactated Ringer's

DISCUSSION: The consensus range for estimating fluid needs of burn patients in the first 24 hours is 2 to 4 ml. of a physiologic crystalloid solution per kilogram body weight per percent of body surface burned. In this patient that would be 9.6 to 19.2 liters of lactated Ringer's solution. The early elevation of circulating levels of catecholamines and glucocorticoids following burn injury induces glycogenolysis, which results in elevated circulating blood glucose levels. Glucose should not be administered in the resuscitation fluids, since the resulting exaggeration of hyperglycemia could induce osmotic diuresis. In the first 24 hours colloid-containing solution is not commonly used, but if it is used even the Evans formula recommends only 1 ml. per kg. body weight per percent of body surface burned. Moreover, patients in one study who received colloid-containing fluids continued to gain weight during the first 3 postinjury days, retained more sodium, and had less urine output than patients who received only crystalloid fluids in the first 24 hours. Hypertonic salt solution is also not commonly used for burn patient resuscitation because of the recently described and surprisingly frequent occurrence of acute renal failure and increased mortality associated with its use. If hypertonic salt is used, the amount infused should be less than 9 liters, to avoid excessive elevation of the serum sodium concentration (i.e., above 160 mEq. per liter). The recommended limit of hydroxyethyl starch infusion is currently 1500 ml. per day. Although a 10% pentastarch form of hydroxyethyl starch has been used to expand the plasma volume of burn patients at the end of the first 24 hours, even as little as 500 ml. of that solution has been reported to prolong both prothrombin and plasma thromboplastin time.