What type of fluid is used for burns? Understanding fluid resuscitation

October 8, 2025 •

3 min read

Burn injuries trigger a massive inflammatory response that causes fluid to shift from the intravascular space into the tissues, leading to severe fluid loss. Knowing what type of fluid is used for burns is a critical component of emergency medical treatment to prevent hypovolemic shock, organ failure, and other severe complications. The choice of fluid depends on the severity and extent of the burn, as well as the patient's age and overall condition.

Quick Summary

This guide details the specific types of intravenous fluids used to manage burns, explaining the rationale behind using balanced salt solutions like Lactated Ringer's. It covers the different fluid categories, appropriate application based on burn size and patient type, and crucial monitoring parameters during resuscitation to avoid complications.

Key Points

Initial Resuscitation Fluid: The preferred fluid for initial burn resuscitation is Lactated Ringer's (LR) solution, a balanced salt crystalloid that helps correct acidosis.
Crystalloids vs. Colloids: Crystalloids like LR are used initially to replace volume, while colloids such as albumin are typically added after 12–24 hours to reduce total fluid needs.
Parkland Formula: Fluid requirements are estimated using formulas like the Parkland formula, which calculates the amount of crystalloid needed based on body weight and the percentage of burned body surface area.
Continuous Monitoring: Fluid administration is a dynamic process that must be continuously titrated based on the patient's hourly urine output to avoid both under- and over-resuscitation.
Pediatric Considerations: Children require special attention, including maintenance fluids and dextrose supplementation (often D5LR), to account for their higher metabolic rate and lower glycogen stores.
Goal of Resuscitation: The primary goal is to prevent burn shock by restoring and maintaining adequate tissue perfusion without causing complications like pulmonary or cerebral edema.

The Primary Role of Fluid Resuscitation in Burn Care

Following a significant burn, capillary leakage causes a substantial shift of plasma and electrolytes from the blood vessels into the interstitial space. This can lead to burn shock and inadequate organ perfusion. Immediate intravenous (IV) fluid resuscitation is vital for patients with significant burns (typically greater than 20% TBSA in adults and 10% TBSA in children) to prevent hypovolemic shock.

Crystalloids: The Foundation of Burn Resuscitation

Crystalloid solutions are the primary fluids for initial burn resuscitation. These solutions contain small molecules that can cross capillary walls. Lactated Ringer's solution (LR) is the almost universally preferred crystalloid due to its physiological similarity to plasma and its ability to help correct acidosis. Using LR in large volumes is less likely to cause hyperchloremic metabolic acidosis compared to normal saline. While other balanced salt solutions may be used, LR is generally favored, especially for large volume resuscitation.

Colloids: Adjunctive Therapy in Later Stages

Colloids contain larger molecules that primarily remain in the intravascular space, increasing osmotic pressure and drawing fluid back into blood vessels. Colloids like albumin or fresh frozen plasma (FFP) are often added after the initial 12 to 24 hours of resuscitation. Introducing colloids too early is avoided because leaky capillaries can allow them to enter the interstitial space and potentially worsen edema. The use of colloids can help reduce the total fluid volume required and mitigate "fluid creep". FFP may also be used to restore coagulation factors in major burns.

Special Considerations for Pediatric Burn Resuscitation

Children require specialized fluid management due to their higher body surface area to mass ratio and increased risk of hypoglycemia. Dextrose supplementation is often necessary to prevent low blood sugar, with solutions like Lactated Ringer's with 5% dextrose (D5LR) commonly used for younger children. Pediatric patients also require weight-based maintenance fluids in addition to resuscitation volumes.

How to estimate fluid requirements: The Parkland Formula

The Parkland formula is a widely used method to estimate initial fluid needs. This formula is a starting point, and fluid rates must be adjusted based on continuous monitoring of the patient's urine output, often via a foley catheter.

Comparison of Burn Fluid Types


Feature	Crystalloids (e.g., Lactated Ringer's)	Colloids (e.g., Albumin, FFP)
Molecular Size	Small	Large
Cost	Less expensive	More expensive
Mechanism	Replaces lost salt and water	Increases plasma osmotic pressure
Timing of Use	Primary for initial resuscitation	Often used after 12-24 hours
Effectiveness	Effective for initial volume expansion	Can reduce total fluid volume needed later
Risk of Edema	Can contribute if over-resuscitated	Lower risk of overall edema if timed correctly
Adverse Effects	Risk of hyperchloremic metabolic acidosis with normal saline	Allergic reactions, clotting disorders (rare)

Titrating Fluids: Avoiding Under- and Over-resuscitation

Fluid administration requires continuous adjustment based on hourly urine output and other clinical signs. Careful titration is essential to prevent complications such as pulmonary edema from over-resuscitation or organ failure from under-resuscitation.

Conclusion

Lactated Ringer's solution is the primary fluid for initial burn resuscitation, addressing volume loss and electrolyte balance. Colloids may be added later to help manage fluid requirements and edema. The specific fluid plan is based on burn severity, patient age, and continuous clinical monitoring, guided by formulas like the Parkland formula. Effective burn resuscitation is a dynamic process of careful fluid titration to optimize patient outcomes. The American Burn Association provides authoritative guidelines for clinicians.

Frequently Asked Questions

The primary fluid used for initial burn resuscitation is Lactated Ringer's (LR) solution. It is a balanced salt solution that helps restore circulating volume and correct acidosis after severe burns.

While normal saline can be used temporarily, large volumes can lead to hyperchloremic metabolic acidosis due to its higher chloride content. LR is preferred because it is more physiologically balanced and less likely to cause this complication.

Colloids are typically introduced after the initial 12 to 24 hours of resuscitation. They help draw fluid back into the intravascular space, which can reduce the total volume of fluid needed and minimize edema.

Formulas such as the Parkland formula are used to estimate initial fluid requirements. This formula takes into account the patient's weight and the percentage of their body surface area that has second or third-degree burns.

Children have a greater body surface area to mass ratio and risk of hypoglycemia due to smaller glycogen stores. Their fluid regimen often includes maintenance fluids with dextrose, in addition to the calculated resuscitation volume.

Fluid creep is the phenomenon where patients receive significantly more fluid than predicted by conventional formulas. This can lead to complications such as pulmonary edema, cerebral edema, and compartment syndrome, and must be avoided through careful titration.

The adequacy of fluid resuscitation is monitored by the patient's hourly urine output. The fluid rate is adjusted based on this output to ensure optimal patient outcomes.