Running head: BURN VICTIMS 1

Fluid Shifts in Burn Victims

Ammon Jensen

Brigham Young University-Idaho

Nursing 422

Brother Sanders

March 29, 2017

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Fluid Shifts in Burn Victims

In 2006, there were 517,000 visits to emergency departments due to burns (Pitts et al.,

2008). Haynes (2016) reported that 3,280 people died in 2015 in incidents related to fires. Those

that have suffered from fire related incidents often bear the burden of scars which are constant

reminders of a possibly terrible event. This paper will discuss the differences in fluid shift during

the emergent and acute phases of the burns.

Emergent Phase

The emergent phase of a major burn is usually about 72 hours beginning from the time

the incident happened. It is during this time that the burn causes the most threat. With all the

damage done to epidermis, dermis, muscles, and even bone, it increases the permeability of the

blood vessels allowing fluids to leak. Sodium, albumin, and other osmotic agents are able to

move outside the blood vessels and cause the fluid to shift into the interstitial spaces. This is the

initial and most influential cause of hypovolemia with burn victims (Lewis et al., 2014).

Two other causes of fluid shift or hypovolemia in burn victims are third spacing and

evaporation. Third spacing is the loss of fluid into formations such as blisters. It can also form

edema in locations that were not burned but are dependent to the area which was burned. Fluid

loss by evaporation is much more prominent because damage done to the epidermis allows for

more fluid to be lost through evaporation (Lewis et al., 2014).

The priority during the emergent phase is fluid replacement with electrolytes. Rapid fluid

and electrolyte shift will result in hypovolemia which is one main causes of death with those that

have major burns. It is important to have two large intravenous catheters inserted to administer

fluids and electrolytes quickly for lifesaving measures. One report found that an excess of fluid
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resuscitation with colloids reduced mortality with fewer complications such as syndrome, but

had a similar to increased rate of pneumonia (Delhunty et al., 2008).

Acute Phase

After lifesaving measures restore fluid to the body and prevent death related to

insufficient fluid volume, the body can start to heal. During this phase, which can last weeks to

months, the body is trying to balance electrolytes and fluids. Sodium and potassium play the

largest parts in the electrolyte balance. Both electrolytes need to be carefully monitored as they

can have polarized effects. During fluid resuscitation during the emergent phase, they can use

excess fluids with isotonic solutions or hypertonic solutions. With sodium, you could have water

intoxication or hypernatremia which would result in increased thirst, and dry mucous membranes

(Lewis et al., 2014).

As with sodium, potassium will have a large effect if it is at an inappropriate level. Hyper

or hypokalemia can result in cardiac dysrhythmias and different muscle complications such as

weakness or cramping. Since both electrolytes are so important, they will be monitored closely

and adjustments will be made with fluid or electrolyte administration.

Conclusion

Although there are many casualties to fires due to major burns, because of the

understanding of the fluid shift during the emergent and acute phases, there are many lives saved.

Interventions can be performed that will allow medical staff to assess where a patient is currently

and make a plan. Current research has proven to be the benefit of all as can be seen with the

knowledge about the fluid shifts during the emergent and acute phases of major burns.
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References

Dulhunty, J. M., Boots, R. J., Rudd, M. J., Muller, M. J., & Lipman, J. (2008). Increased fluid

resuscitation can lead to adverse outcomes in major-burn injured patients, but low

mortality is achievable. Burns, 34(8), 1090-1097.

Haynes, H. (2016, September). Fire loss in the United States. Retrieved from

http://www.nfpa.org/news-and-research/fire-statistics-and-reports/fire-statistics/fires-in-

the-us/overall-fire-problem/fire-loss-in-the-united-states

Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., Knighton, J. (2014). Medical-Surgical

Nursing: Assessment and Management of Clinical Problems, 9th Edition

Pitts, S. R., Niska, R. W., Xu, J., & Burt, C. W. (2008). National hospital ambulatory medical

care survey: 2006 emergency department summary. Natl Health Stat Report, 7(7), 1-38.