In burn patients, what is the primary immediate concern for those with extensive burns?

• A. Hypervolemia.
• B. Infection.
• C. Pain control.
• D. Hypovolemia.

Answer: (D)

Extensive burns trigger a rapid loss of intravascular fluid because the injury makes capillaries leak fluid into the burned tissue and surrounding interstitial space. This shift dramatically reduces circulating blood volume, impairing tissue perfusion and risking shock. The immediate goal is to restore and maintain adequate intravascular volume through prompt fluid resuscitation, so organs continue to receive blood and oxygen. Tools like crystalloid-based resuscitation (often guided by a formula and urine output targets) help achieve this balance in the first 24 hours; monitoring is essential to avoid under-resuscitation, which keeps perfusion compromised, and over-resuscitation, which can cause fluid overload and edema. While infection control and pain management are important, they do not address the urgent physiologic deficit caused by the capillary leak—hypovolemia.