In burn resuscitation, what best indicates effectiveness of fluid resuscitation?

• A. Stable arterial pressure
• B. Adequate urinary output
• C. Normal capillary refill
• D. Decreased heart rate

Answer: (B)

Maintaining adequate urine output is the best indicator of effective fluid resuscitation because it directly reflects sufficient renal perfusion and overall intravascular volume. In burn patients, the body experiences capillary leak and massive fluid shifts, so blood pressure alone can be preserved by compensatory mechanisms even when tissue perfusion is suboptimal. Capillary refill is influenced by temperature and age, making it unreliable as a sole measure. Heart rate is affected by pain, stress, and other factors and does not reliably show whether fluid needs are being met. Urine output, by contrast, provides a functional endpoint: if the kidneys are receiving enough perfused blood, urine flow increases; persistently low output signals under-resuscitation and prompts fluid titration. In adults, the target is about 0.5 mL/kg/hr, while in children it’s closer to 1 mL/kg/hr, with adjustments for kidney function and diuretics.