A 32-year-old patient sustains 40% TBSA deep partial and full-thickness burns. At 36 hours, Parkland formula resuscitation has delivered 12 L crystalloid. Urine output was 30 mL/hr but has now fallen to 10 mL/hr. What is the most likely cause and management?

• A Hypovolemia — increase crystalloid rate by 50%
• B Acute tubular necrosis — start furosemide infusion
• C Contrast nephropathy from CT scanning
• D Abdominal compartment syndrome — measure bladder pressure and consider escharotomy/decompressive laparotomy ✓

Explanation

After large-volume burn resuscitation exceeding 0.25 mL/kg/%TBSA, abdominal compartment syndrome (ACS) is a well-recognized complication. Visceral edema from massive fluid resuscitation raises intraabdominal pressure, impairing renal perfusion and causing oliguria unresponsive to further fluids. Bladder pressure measurement (normal <15 mmHg; ACS defined as >20 mmHg with end-organ dysfunction) is the immediate step. Management includes escharotomy of truncal burns, reduction of infusion rate, prokinetics, and in refractory cases, decompressive laparotomy. Increasing crystalloid worsens abdominal compartment syndrome. Furosemide is contraindicated in hypovolemic states.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.