Which of the following statement(s) is/are true concerning the initial fluid resuscitation of a burn patient?

e. Most resuscitative formulae withhold colloid solutions until 24 hours post-injury

The large number of fluid resuscitation formulae in common use is attributed to the fact that no formula accurately predicts fluid requirements in every patient. No formula can replace a physician at the bedside repeatedly evaluating the patient’s physiology through the resuscitative period. A reasonable consensus formula is the Modified Brooke formula, however, regardless of the formula chosen to initiate resuscitation, subsequent fluid administration is best guided by regular assessment of the resuscitation end points, rather than prediction of any formula. Vasoactive mediators released from the injured tissue result in diffuse capillary leaks seen shortly after major burn injury with resulting extravasation of both crystalloid and colloid for the first 18 to 24 hours after burn. The pathophysiology explains the enormous volume requirements seen in such patients and is the reason that most resuscitative formulae withhold colloid until 24 hours post-injury. Children have been found to commonly require fluid in excess of that predicted by several formulae. These requirements are generated if one uses a urine output of 1–2 cc/kg/hour as a resuscitation end point. These needs are real in infants and very young children whose renal concentrating abilities are not completely mature. However, in toddlers and older children whose concentrating abilities are more mature, targeting urine flow of 0.5–1 cc/kg/hour results in overall fluid requirements closer to that of an adult and less overall edema. Patients with inhalation injury have demonstrated to have overall volume requirements greater than that predicted by standard formulae, possibly secondary to release of vasoactive mediators from injured burned parenchyma. During the first 24 hours, Ringer’s lactate is the primary resuscitative fluid. Because children less than 10 kg can develop hypoglycemia if glucose is not administered, Ringer’s lactate or half normal saline with 5% dextrose at a maintenance rate is given along with the reduced amount of Ringer’s lactate. Dextrose containing fluids should not be given as a primary resuscitative fluid in adults, as hyperglycemia and osmotic diuresis will result.