What is the recommended fluid management for patients with mild burns?

Fluid Management for Mild Burns

For patients with mild burns (<10% TBSA in adults or <5% in children), no intravenous fluid resuscitation is typically required, but adequate oral hydration should be maintained. 1

Initial Assessment and Classification

• Mild burns are typically defined as those covering less than 10% of total body surface area (TBSA) in adults and less than 5% in children 1
• Burns involving the face, hands, feet, genitals, or those with full-thickness involvement require specialized care regardless of size 1
• Signs of inhalation injury (facial burns, difficulty breathing, singed nasal hairs, soot around nose/mouth) require immediate emergency medical services activation 1

Immediate Management

• Thermal burns should be cooled immediately with clean running water for 5-20 minutes 1
• Monitor preadolescent children for signs of hypothermia during cooling 1
• Remove jewelry before the onset of swelling to prevent constriction and vascular ischemia 1
• Over-the-counter pain medications (acetaminophen or NSAIDs) are recommended for pain management 1

Fluid Management Protocol for Mild Burns

Adults with <10% TBSA Burns:

• No specialized fluid resuscitation formula is required 1
• Maintain normal oral fluid intake with regular beverages 2
• If unable to tolerate oral fluids, consider oral rehydration solution (ORS) to maintain hydration 3, 4

Children with <5% TBSA Burns:

• No specialized fluid resuscitation formula is required 1, 5
• Encourage regular oral fluid intake appropriate for age 5
• Monitor for signs of dehydration more closely than in adults due to children's higher body surface area to weight ratio 5

Wound Care After Cooling

• For small partial-thickness burns managed at home, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1
• Cover with a clean nonadherent dressing 1
• For burns with intact skin or intact blisters, loosely cover with a clean cloth or nonadherent dry dressing 1

When to Escalate Care

• Burns requiring specialized fluid resuscitation include:
  • Adults: Burns covering ≥10% TBSA 1
  • Children: Burns covering ≥5% TBSA 1, 5
  • Any burn involving face, hands, feet, or genitals 1
  • All full-thickness burns 1
• For these cases, transfer to a specialized burn center is recommended 1

Alternative Fluid Management When IV Access Unavailable

• In resource-limited settings or mass casualty situations where IV access is unavailable, oral rehydration solution (ORS) can be considered for moderate burns 3, 4
• WHO-ORS has shown effectiveness in burn resuscitation for burns >15% TBSA when IV resuscitation is not feasible 3
• ORS has demonstrated ability to improve kidney function following burn injury in research settings 6

Monitoring Parameters for Mild Burns

• Adequate hydration status (moist mucous membranes, normal skin turgor) 2
• Normal urine output (approximately 0.5-1 mL/kg/hr) 1
• Stable vital signs 3
• Pain control 1