Use of oral rehydration therapy in burns Ceralyte®90 (Table 1) to titrate the urine output to a target range of 0.5-1.0 cc/kg/hour. For urine out- Table 1. Composition of Ceralyte®90 Ingredient Amount Rice carbohydrate 40 g Sodium 90 mEq/L Potassium 20 mEq/L Chloride 80 mEq/L Citrate (base) 30 mEq/L Osmolarity 270 mOsm/L puts of <0.5 cc/kg/hour, ORT was increased by 100 cc/hour, and for urine outputs of >1 cc/kg/hour, IV fluids were decreased by 100 cc/hour. Gastric resid- uals were checked every two hours, and if greater than 300 cc, oral fluids were stopped. RESULTS All the patients tolerated the administration of ORT with gastric residuals of less than 300 cc which were monitored every two hours. The characteris- tics of the patients are defined in Table 2. We were Milner SM et al. of patients with burns of ≥20% of the TBSA. With- out intervention, the loss of fluids and electrolytes into burned tissues rapidly leads to hypotension and shock. In major burns, early resuscitation fluid is required to maintain circulation and adequate tissue perfusion. Volume losses occur most rapidly in the first 6-8 hours but continue for 18-36 hours or longer (8). Standardized formulae have been de- veloped to guide the amount of IV fluids required for adequate resuscitation (9,10). However, mass thermal casualty events may disrupt logistics and limit access to resuscitation strictly by the IV route which requires skilled medical technical personnel and equipment. ORT is a proven safe and effective alternative to IV resuscitation in epidemic cholera, a disease which causes rapid loss of fluids from the gut, leading to circulatory collapse and death. Oral rehydration so- lutions (ORS) take advantage of a robust back-up mechanism for intestinal absorption of salts and water, in addition to the normal absorption which is mediated by a sodium chloride-linked transport system at the brush border of the intestinal epi- Table 2. Patient demographics and 24-hour intravenous fluid requirements per Parkland Formula Patient Age (years) %boufrnTeBdSA Weight (kg) IVTForermquuilrae mcce/n24t (hPoarukrlsa)nd 1 48 20 60.5 4,840 2 44 25 104.4 10,450 3 31 40 111.8 17,888 IVT=Intravenous fluid therapy; TBSA=Total body surface area able to replace a maximum of 77.5% of the IV fluid requirement, with a mean of 65.2% and range of 57.4-77.5% (Table 3). The patients maintained thelium. This active transport moves sodium with chloride from the intestinal lumen into the cell. Cellular sodium potassium ATPase extrudes sodi- Table 3. Fraction and percentage of Parkland goal given by the enteral route Patient ORT/24 hours/Parkland goal % given 2as4ehnotuerrasl fluid in 1 2,613/4,840 60 2 8,098/1,0450 77.5 3 10,267/17,888 57.4 ORT=Oral rehydration therapy urine output within the target range throughout the course of the study, without electrolyte abnor- malities, indicating adequacy of tissue perfusion with the ORT supplementation. DISCUSSION We reviewed the literature on oral fluid replace- ment in burns but found only one report on the use of ORT in burns in humans, which treated burns (10-20%) in children. Resuscitation of IV flu- id is the current standard of care for the treatment Volume 29 | Number 6 | December 2011 um into the lateral cell spaces, creating an osmotic and electrochemical gradient that produces a net flow of water and solutes from the lumen into the bloodstream (11,12). This sodium-glucose transporter of the intestinal epithelium allows absorption of sufficient water and electrolytes to restore the large fluid losses even in severe diarrhoeal diseases when the normal absorptive mechanism is impaired (12). The World Health Organization (WHO) estimated that ORT currently saves more than three million lives every 649