How should a burn patient be managed in terms of fluid type and monitoring during resuscitation?

• A. Lactated Ringer's solution as primary fluid; monitor hourly urine output (0.5–1 mL/kg/h) and adjust rate; avoid hypotonic fluids
• B. Normal saline; monitor blood pressure only
• C. Dextrose-containing fluids; no urine output targets
• D. Lactated Ringer's but avoid monitoring urine output

Answer: (A)

During burn resuscitation, the priority is to restore circulating volume with an isotonic fluid that best matches plasma composition and supports acid–base balance. Lactated Ringer’s is preferred because it provides electrolytes similar to plasma and a bicarbonate precursor (lactate) to help counter burn‑related metabolic acidosis, helping maintain perfusion without causing excessive chloride load.

The most reliable indicator to guide resuscitation is urine output. Aim for about 0.5–1 mL/kg/hour and adjust the IV rate to keep that target, updating hourly. This direct measure of kidney perfusion reflects adequacy of circulating volume better than blood pressure alone, which can stay normal even when perfusion is insufficient. Avoid hypotonic fluids, which can exacerbate cellular edema and hyponatremia. Dextrose‑containing fluids aren’t ideal for initial resuscitation because they don’t provide appropriate intravascular support and can worsen glycemic control. Monitor for signs of fluid overload in addition to urine output, and tailor the rate to maintain stable urine output and perfusion.