In extensive, deep burns, fluid requirements may be in excess of that calculated by the accepted regimen. To avoid fluid overload, it is worth considering hypertonic saline as a means of reducing the absolute volume of fluid administered; the increased osmolality of the interstitial fluid draws water from cells.
If the ongoing fluid requirements are more than twice that predicted by the Parkland Formula despite using hypertonic saline, it is worth considering the use of plasma exchange. This should be discussed with the regional burns unit.
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