Prospective, Randomized Trial of Hypertonic Sodium Lactate Versus Lactated Ringerʼs Solution for Burn Shock Resuscitation

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Abstract
We prospectively randomized 51 adult burned patients on admission to study fluid, electrolyte, and physiologic parameters during burn resuscitation with the use of hypertonic saline (HSL, Na 250 mEq/L, 514 mOsm) or lactated Ringer''s solution (LR, Na 130 mEq/l, 268 mOsm). Patients suffered at least 20% total body surface area burns (BSA); the mean BSA injury was 36.7% BSA, with a range of 20 to 74% BSA. All patients were admitted to our Burn Center within at least 12 hours of injury. Laboratory studies included frequent determinations of serum chemistries including osmolalities, and continuous 24-hour urine collections for electrolytes and osmolality determinations. Fluid requirements (cc/kg/% BSA), urine output (cc/kg/hr), sodium intake and excretion (mEq/kg/% BSA), serum and urine osmolality (mOsm/kg), serum creatinine (mg/dl), body weight (kg), and enteral intake (cc/24 hrs and calories/24 hrs) were analyzed for comparison at 24-hour intervals following burn injury. Using Student''s t-test, significance was attributed to a p < 0.05. Nonparametric methods were used to compare non-normalized data. Regression analysis was used to compared sodium intake (mEq/kg) and fluid intake (cc/kg) between the HSL and the LR groups in relation with LR for burn resuscitation. We were not able to demonstrate decreased fluid requirements, improved tolerance of feedings, or decrease in per cent weight gain. However, in light of our policy of aggressively enterally feeding our patients within hours of admission (a less common practice several years ago when some previous studies were performed), we may be negating some of the intravascular and cellular effects of HSL by giving extra free water in the form of tube feedings in the early postburn period.