Lactated Ringer's (LR) solution, also known as Hartmann's solution, is preferred in burn resuscitation primarily because its composition closely resembles the body's physiological fluids and it can help buffer metabolic acidosis that often occurs after a burn injury.
Detailed Explanation:
The use of appropriate intravenous fluids is crucial in the management of burn patients, particularly in the acute resuscitation phase. LR solution offers several advantages over other fluid types like normal saline (0.9% NaCl):
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Composition Similar to Plasma: LR contains electrolytes like sodium, chloride, potassium, calcium, and lactate in concentrations similar to that of blood plasma. This reduces the risk of electrolyte imbalances compared to solutions like normal saline, which has a higher chloride concentration.
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Buffering Capacity: Burn injuries often lead to metabolic acidosis due to hypovolemia, decreased tissue perfusion, and the release of acidic metabolites. LR contains lactate, which the liver converts to bicarbonate, a natural buffer that can help correct the acidosis.
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Reduced Risk of Hyperchloremic Acidosis: Large volumes of normal saline administration can lead to hyperchloremic metabolic acidosis (an acidosis caused by excess chloride), which can negatively impact kidney function and oxygen delivery to tissues. LR minimizes this risk due to its lower chloride content.
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British Burns Association Recommendation: The British Burns Association recommends LR as the first-line fluid for burn resuscitation, underscoring its widespread acceptance and efficacy in burn management.
Comparison with Other Fluids
| Fluid Type | Advantages | Disadvantages |
|---|---|---|
| Lactated Ringer's | Similar to plasma, buffers acidosis, lower risk of hyperchloremia | May not be suitable for patients with severe liver dysfunction (due to lactate metabolism) |
| Normal Saline | Readily available, inexpensive | Can cause hyperchloremic acidosis, electrolyte imbalances |
| Colloids | Can expand plasma volume more efficiently (but their use remains controversial) | Higher cost, potential for allergic reactions, no clear survival benefit over crystalloids |
In summary, Lactated Ringer's solution is favored in burn resuscitation because its composition is physiologically appropriate for burn patients, helping to restore fluid balance and address metabolic acidosis with a reduced risk of complications associated with alternative fluid choices.
