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Albumin supplementation during the first week after a burn does not mobilise tissue oedema in humans
Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
The National Laboratory of Forensic Chemistry, University Hospital, Linköping, Sweden.
Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
2001 (English)In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 27, no 5, 844-852 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To measure water balance and changes in distribution, and the effect of giving supplementary albumin, early after a burn injury.

Design: Consecutive patients (matched groups) and healthy controls.

Setting: National burn unit in a Swedish university hospital.

Patients and subjects: Eighteen patients with 18%-90% total burned surface area and 16 healthy male control subjects.

Interventions: The patients were given an intravenous infusion of ethanol over 1 h, 0.35-0.60 g/kg body weight, and a bolus of 3.3 to 6.5 g of iohexol. The control subjects were given the same amounts of either ethanol or iohexol. Patients were subdivided into two groups according to whether or not they received supplementary albumin starting 12 h post-burn.

Measurements and results: Blood samples were drawn at 20-30 min intervals over 4 h after the start of the infusion. Serum ethanol was measured by headspace gas chromatography, and iohexol with high-pressure liquid chromatography (HPLC). Distribution volume was calculated from the concentration-time profiles. Total body water (TBW) was measured by the ethanol tracer and bioelectric impedance (BIA) techniques, and estimated extracellular water (ECWest) by iohexol tracer. They were all significantly increased after a burn. Excess water was accumulated mainly in the extracellular compartment. It declined towards normal values (those of volunteers) at the end of the week. Albumin supplementation did not influence the amount or distribution of the excess fluid.

Conclusion: Body water increases after a burn. Excess water is mainly deposited in the extracellular space. Tissue oedema fluid is not mobilised by albumin supplementation.

Place, publisher, year, edition, pages
2001. Vol. 27, no 5, 844-852 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-25136DOI: 10.1007/s001340100935Local ID: 9569OAI: oai:DiVA.org:liu-25136DiVA: diva2:245462
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-08-09Bibliographically approved
In thesis
1. Water physiology in burn victims
Open this publication in new window or tab >>Water physiology in burn victims
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Patients who sustain a burn injury of more than 20 - 30 % TBSA will, if untreated, develop burn shock within a couple of hours. Flcid is lost fi·om the vascular compartment due to suction from the interstitium of the wound and due to a generalised increase in vascular permeability. To prevent bum shock intravenous fluids are given during the first two days after a bum in order to ensure adequate organ perfusion. Although organ perfusion will be improved when blood volume is restored, the fluid provided will add to the continuing leak into the tissues. With fluid treatment the patient survives the acute stage, but the resulting oedema interferes with the healing of the burn wound and partially damaged skin may be further compromised.

To describe, follow and understand the development of the general oedema in burn injured patients we used four different techniques. Ethanol dilution was used for measurement of total body water (TBW), iohexol dilution in order to estimate extracellular volume (ECV), bioimpedance analysis (BIA) to register TBW as well as electrical membrane properties and the impression method (IM) for the measurement of visco-elastic properties in non-burned tissues. In order to further examine the non-invasive techniques (BIA and IM) these were used in patients subjected to haemodialysis.

The excess fluid was found to be accumulated in the extracellular space. Interesting alterations in the visco-clastic properties of the skin and cellular electrical membrane properties could also be detected. These alterations were not related to the actual tluid volume in the tissues. Instead, they were related to changes in the fluid equilibrium of the tissues. Still, one week postbum an excess of tissue fluid, altered cellular electrical membrane properties and changed visco-elastic properties of the skin remained.

Albumin supplementation did not influence the amount or distribution of the excess tissue fluid, measured with dilution techniques.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2000. 61 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 633
Keyword
Total body water, Extracellular fluid, Burn, Bioelectrical impedance, Oedema, Extracellular matrix
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27560 (URN)12222 (Local ID)91-7219-734-X (ISBN)12222 (Archive number)12222 (OAI)
Public defence
2000-05-27, Berzeliussalen, Universitetssjukhuset, Linköping, 08:30 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2015-06-09Bibliographically approved

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Zdolsek, Hans JoachimLisander, BjörnJones, Wayne A.Sjöberg, Folke

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