ALTERNATIVE STRATEGY: ENTERAL RESUSCITATION

Enteral resuscitation, also known as oral rehydration therapy, can be used in addition to or instead of IV fluids.21,22 (See Appendix G for the Oral Resuscitation Protocol.) Such fluids can be consumed orally (ideal route) by an awake and alert patient. They can also be administered via a nasogastric tube, orogastric tube, or by proctoclysis (enema). If given enterally, the resuscitation solution must be administered to the stomach and not directly to the small bowel due to large volumes required for resuscitation. Reasons for avoiding enteral resuscitation include the following:

- Abdominal injuries
- Gastrointestinal intolerance (vomiting)
- Pressor use >15mcg/min of norepinephrine (with or without vasopressin)
- Burns >40% TBSA (will likely need IV fluid augmentation).

Enteral resuscitation must include fluids that have salt, sugar, and are isotonic. Fluids like Gatorade will result in severe hyponatremia. Patients undergoing enteral resuscitation should be monitored for gastric residuals or vomiting. Enteral resuscitation through an NG tube/enteral tube must ensure that the fluid is gastric and not small bowel.

Titration and Goals of Fluid Resuscitation

Diligent fluid resuscitation in the first 24-48 hours prevents development of multiorgan failure in the setting of burn shock. This is why maintaining goals of resuscitation is essential in the care of a burn patient.

Urine Output:

1. 30-50 mL/hour in adults, or 0.5 to 1 ml/kg/hr in children

a. If UOP > 50 mL/hr, then decrease the IV fluid rate by 20%, wait two consecutive hours, and reassess.

b. If UOP < 30 mL/hr, then increase rate of IV fluids by 20%, wait two consecutive hours, and reassess.

2. 75-100 mL/hr for high-voltage electrical injury, or other conditions causing rhabdomyolysis