Research progress and considerations on oral rehydration therapy for the prevention and treatment of severe burn shock: A narrative review

Severe burns are an important cause of life-threatening situations, whether in times of peace or war. Shock represents a critical complication during the early stages of burn injury and is a significant contributor to mortality and long-term disability. Effective fluid resuscitation is a crucial intervention for preventing and treating shock, and prompt administration is paramount. In numerous instances, prompt initiation of intravenous fluid resuscitation proves challenging and research indicates that resuscitation errors remain a critical contributor to the mortality of injured patients. Hence, it is imperative to explore a more expedient and efficacious non-invasive method for fluid resuscitation that can serve as a fundamental basis for the subsequent treatment of such individuals. There has been extensive research recently on the utilisation of oral rehydration, which exhibits vast potential for application in austere settings. This paper summarizes the historical development and research progress in oral rehydration therapy, briefly discusses the pathogenesis of burns, summarizes the characteristics of burn fluid resuscitation and discusses the application status of oral rehydration therapy in the early anti-shock treatment of burns. It aims to explore an effective fluid resuscitation method suitable for special conditions and provides ideas for improving the level of treatment for shock in peacetime and wartime. Oral rehydration therapy is generally considered safe; however, there are potential complications to be aware of. These include gastrointestinal discomfort such as diarrhoea, vomiting, and abdominal discomfort, particularly when the rehydration rate is too fast or there are preexisting gastrointestinal issues in the patient. Furthermore, it is important to note that oral rehydration therapy may not be appropriate for individuals suffering from gastrointestinal tract impairments. Therefore, when administering oral rehydration therapy, it is imperative for the physician to carefully assess the patient’s condition and closely monitor their response and tolerance. Based on a comprehensive review of research in relevant fields, we carefully present the following provisional guidelines for oral rehydration therapy in burn patients. It is critical to emphasize that, despite these guidelines being intended to inform clinical practice, they should be applied with caution due to the lack of robust clinical evidence. Implementation should either be cautious, considering the specifics of the patient’s condition, or conducted under the supervision of healthcare professionals. Additionally, these guidelines should be dynamically adjusted in response to the unique circumstances and evolving condition of each patient: ① Initiation timing: Start as soon as possible, and the ideal start time is usually within 6 h after injury. ② Rate of application: Employing a fractional administration approach, wherein small quantities of approximately 150–250 millilitres are provided for each instance and the initial fluid rate of oral rehydration can be simplified to 100 mL/kg/24 h. ③ Composition combination: In addition to essential salts and glucose, the oral rehydration solution can incorporate various anti-inflammatory and cellular protection constituents such as pyruvate, vitamins, teprenone or glutamine.