Oliguria in major burns

Oliguria in major burns usually is due to inadequate fluid resucitation. It is more likely in the following groups:

• inhalation damage to lung
• electrocution
• delay before resuscitation
• children
• dehydrated individuals, e.g. excess alcohol consumption

Oliguria should prompt a fluid challenge:

• supplementary bolus of 5-10 mls / kg, or
• increase the next hour's estimated volume by 50%

However, caution must be exercised in the following groups with reduced ability to compensate for fluid shifts:

• children
• elderly patients
• patients with cardiac compromise

Invasive monitoring of cardiac preload and afterload may be warranted in the setting of the HDU/ITU.

Generally, diuretics should not be used in response to oliguria in the patient with a major burn injury. An exception to this rule may be haemochromogenuria under the guidance of the burns unit or a renal physician.

Whenever a fluid challenge is given, the patient must be reassessed a short time later to determine their response.