The role of concentrated sodium solutions in the resuscitation of patients with severe burns

Seventy-four severely burned patients were resuscitated with intravenous crystalloid solutions that varied in their average sodium concentration. No colloid solution was used. During the first 24 hours, when requirements were greatest, 21 patients received fluids containing less than 150 mEq sodium/L, nearly all of which was lactated Ringer's solution, while for 31 patients the fluids contained more than 199 mEq sodium/L; the remaining 22 patients were treated with fluids of intermediate sodium content (150 to 199 mEq/L). Detailed, computer-assisted analysis of the data was performed. There were no significant intergroup differences in mean hourly urine output, which was in the targeted range of 0.5 to 1 ml/kg, or in urinary sodium excretion. Both the sodium and water loads administered were significantly larger in patients who died than in survivors (P<0.0025). This observation is new. The use of concentrated sodium solutions did not increase the sodium requirement, but water loads were significantly lower in patients who received the most concentrated sodium solutions compared to those resuscitated with the least concentrated sodium solutions (P<0.014). The data suggest that minimizing the water loads during resuscitation by increasing the sodium content of the administered fluid might improve the chance for survival of severely burned patients.