Pediatric Fluid Resuscitation in case of Thermal Injury

An appropriate pediatric fluid resuscitation is very important component of pediatric first aid. An inadequate fluid resuscitation after burns can lead to fatal consequences like tissue ischaemia, renal failure, and extension of indeterminate depth wounds to full-thickness injury.

Administration of fluids need to be handled with extreme caution as excessive use can result in pulmonary oedema, heart failure, compartment syndrome (either of the extremities, chest, or the abdomen), and extension of indeterminate wounds to full-thickness injury.

When is Parenteral Fluid Resuscitation needed?

Parenteral fluid resuscitation is not required in case of minor burns. A child with less than 10% BSA superficial burns does not need parenteral fluids. Deep burns need parenteral resuscitation. Whether minor or major burns, each case needs to be individualized. An infant not willing to take anything orally may need parenteral fluids.

Why does a Thermal Injury need Fluid Resuscitation?

Thermal injury restricts the ability of a body to conserve water. Dehydration can develop very fast. Thermal injury produces major fluid losses from a variety of causes within first 24–36 hours. Immediately after thermal injury, there is an increase in capillary permeability. Water, electrolytes and proteins freely escape from the intravascular to the interstitial spaces. Generalized oedema occurs primarily in the area of injury. Fluid loss has been believed to be most severe during the eight hours immediately after the burns. Therefore most fluid resuscitation formulae should be administered within half of the 24 hours requirement in first eight hours.

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