A patient with TEN involving 50% BSA is admitted to the ICU. Which fluid resuscitation strategy is most appropriate in the first 24 hours?
- A Aggressive crystalloid resuscitation similar to the Parkland formula for burns
- B Colloid-only resuscitation with 5% albumin
- C Moderate crystalloid resuscitation guided by urine output (0.5 mL/kg/hr), avoiding over-resuscitation ✓
- D Fluid restriction to prevent pulmonary edema from capillary leak
Correct answer: C. Moderate crystalloid resuscitation guided by urine output (0.5 mL/kg/hr), avoiding over-resuscitation
Explanation
TEN patients have increased insensible losses but do not require the aggressive Parkland formula resuscitation used in thermal burns. Over-resuscitation leads to pulmonary edema, wound maceration, and compartment syndrome. Moderate crystalloid resuscitation targeting a urine output of 0.5 mL/kg/hr is recommended. The damaged skin in TEN acts as a biologic dressing, and excessive fluids worsen edema in denuded areas. This represents a key difference from burn fluid management.
Reference: Bolognia's Dermatology, 4th ed.
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Written and medically reviewed by the StethoPrep medical team.