What is the appropriate fluid replacement for a patient with severe burns?

For a patient with severe burns, the appropriate fluid replacement is Lactated Ringer's solution. This choice is primarily due to its composition, which is designed to better match the body’s needs during the acute phase of burn resuscitation.

Lactated Ringer's contains electrolytes such as sodium, potassium, calcium, and lactate, which can help buffer metabolic acidosis—a common issue encountered in burn patients due to tissue damage and fluid shifts. The lactate in the solution allows for conversion to bicarbonate by the liver, helping to correct any acidosis that may occur after significant trauma, including burns.

Additionally, the use of Lactated Ringer's is generally preferred over normal saline because the latter can lead to hyperchloremic acidosis when used in large volumes due to its higher chloride content. In contrast, solutions such as 5% dextrose in water provide no adequate electrolyte replacement, making them unsuitable for effective resuscitation in burn patients. Plasma-Lyte A, while also a balanced solution, is less commonly used than Lactated Ringer's in the acute management of burns.

In summary, Lactated Ringer's solution is the most appropriate choice for fluid replacement in patients with severe burns due to its