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METABOLIC EFFECTS OF TOPICAL SILVER NITRATE THERAPY IN BURNS COVERING MORE THAN FIFTEEN PERCENT OF THE BODY SURFACE *
Author(s) -
Burke J. F.,
Bondoc C. C.,
Morris P. J.
Publication year - 1968
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/j.1749-6632.1968.tb14719.x
Subject(s) - burn wound , body surface area , total body surface area , excretion , chemistry , urinary system , thermal burn , urine , burn injury , electrolyte , medicine , zoology , surgery , endocrinology , biochemistry , wound healing , biology , electrode
S ummary Electrolyte and water balance studies have been carried out on 20 patients with total body surface burns ranging from 15 to 85%. All patients were treated with 0.5% aqueous AgNo 3 applied directly and continuously to the burn wound. The balance studies showed that the loss of Na through the burn wound was directly related to the square area of burn surface and was constant from day to day. Based on this steady and predictable loss of Na in the uninfected burn, a formula has been derived predicting the daily Na replacement necessary to cover the obligatory loss via the burn wound plus the requirements of normal metabolism. This formula has provided an accurate prediction of daily Na requirements in the treatment of thermal burns of widely varying extent, in patients of widely different ages, as judged by water and electrolyte balance studies. The formula provides a useful guide to the level of Na replacement required. Exact tailoring must be carried out to fit the needs of each patient. The direct monitoring of the accuracy of Na replacement by way of the serum Na level has been found cumbersome but intermittently necessary. In the burn patient in metabolic balance and taking a reasonable diet, the level of urinary excretion of Na has been found to be an accurate prediction of serum Na level. A urinary excretion of 40 mEq of Na per liter or above has uniformly reflected a normal serum Na level. The urinary Na has been used as an indicator of accurate replacement therapy replacing the majority of serum Na determinations.