A client with 50% body surface area burns is 48 hours postadmission. Urine output is 50 mL/h, urine specific gravity 1.015, hematocrit 0.42, albumin 3.6 g/dL, and PAWP 10 mm Hg. Which conclusion is most appropriate?

A client with 50% body surface area burns is 48 hours postadmission. Urine output is 50 mL/h, urine specific gravity 1.015, hematocrit 0.42, albumin 3.6 g/dL, and PAWP 10 mm Hg. Which conclusion is most appropriate?

• A. Albumin is critically low.
• B. Fluid therapy is successful.
• C. Kidney failure is impending.
• D. Hemoconcentration is occurring.

Answer: (B)

In burn care, fluid status is judged mainly by how well the kidneys are perfusing, which is reflected in urine output and central perfusion pressures. At 48 hours after a large burn, a urine output of 50 mL/hour suggests the kidneys are receiving enough blood flow, indicating the current fluid therapy is achieving adequate intravascular volume. Urine output in adults is typically targeted around 0.5 mL/kg/hour; for a typical 70 kg patient that’s about 35 mL/hour. So 50 mL/hour exceeds the target and supports successful resuscitation. The PAWP of 10 mm Hg is within normal preload range, the albumin level of 3.6 g/dL is not critically low, and the hematocrit of 0.42 is not indicating hemoconcentration. Taken together, these values point to effective fluid management rather than ongoing dehydration or fluid overload. Thus, the most appropriate conclusion is that fluid therapy is successful.

In burn care, fluid status is judged mainly by how well the kidneys are perfusing, which is reflected in urine output and central perfusion pressures. At 48 hours after a large burn, a urine output of 50 mL/hour suggests the kidneys are receiving enough blood flow, indicating the current fluid therapy is achieving adequate intravascular volume.

Urine output in adults is typically targeted around 0.5 mL/kg/hour; for a typical 70 kg patient that’s about 35 mL/hour. So 50 mL/hour exceeds the target and supports successful resuscitation. The PAWP of 10 mm Hg is within normal preload range, the albumin level of 3.6 g/dL is not critically low, and the hematocrit of 0.42 is not indicating hemoconcentration. Taken together, these values point to effective fluid management rather than ongoing dehydration or fluid overload.

Thus, the most appropriate conclusion is that fluid therapy is successful.