title: Progressive fluid removal can avoid electrolyte disorders in severely burned patients.
abstract: BACKGROUND
  Extensive burn injury has systemic consequences due to capillary leak. After restoration of cellular integrity, infused fluid volume has to be removed partially. This can provoke electrolyte disorders.
  
  
  OBJECTIVE
  We investigated the effect of progressive fluid removal on serum sodium level.
  
  
  METHODS
  Retrospective study. Patients admitted to a burn unit were analyzed and separated in two groups without (Group A) or with (Group B) prolonged hypernatremia. Daily infusion-diuresis-ratio (IDR) was analyzed.
  
  
  RESULTS
  Fourty (12 female; 28 male) patients with a mean age of 47±19 years, a total burn surface area (TBSA) of 26±12%, and a mean abbreviated burned severity index (ABSI) score of 7.3±2 were included. In Group A 25 patients with a mean age of 47±18 years, a mean TBSA of 23±11%, and a mean ABSI score of 6.9±2.1 were summarized. In Group B 15 patients with a mean age of 47±22 years, a mean TBSA of 30±13%, and a mean ABSI score of 8.1±1.7 were included. Hypernatremia occurred on day 5±1.4. There was no significant difference between both groups for fluid resuscitation amount within the first 24 hours. Statistical analysis of the first 7 days after burn injury showed a significantly higher percentage of removed fluid in Group B for day 3, day 4, day 5, day 6 and day 7.
  
  
  CONCLUSIONS
  Amount and velocity of fluid removal regimen after burn injury can provoke electrolyte disorders. Serum sodium concentration can be used to calculate need of fluid resuscitation for fluid maintenance. There is a need of an established fluid removal strategy.
authors.affiliation: Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany. NamdarMD@yahoo.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Namdar
authors.forename: Peter Leonard
authors.initials: PL
authors.lastname: Stollwerck
authors.forename: Felix Hagen
authors.initials: FH
authors.lastname: Stang
authors.forename: Georgios
authors.initials: G
authors.lastname: Kolios
authors.forename: Thomas
authors.initials: T
authors.lastname: Lange
authors.forename: Peter
authors.initials: P
authors.lastname: Mailänder
authors.forename: Frank
authors.initials: F
authors.lastname: Siemers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002056:Burns / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D018495:Fluid Shifts / Q000502:physiology*; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D006955:Hypernatremia / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014882:Water-Electrolyte Balance / Q000502:physiology*; D055815:Young Adult