Which of the following is expected in a burn patient?

• A. Hyperkalemia and hypovolemia
• B. Hyperkalemia alone
• C. Hypokalemia and hypervolemia
• D. Normal electrolytes

Answer: (A)

In burns, two things happen early on: a lot of fluid leaks out of the vessels because capillaries become highly permeable, causing hypovolemia; and damaged cells release potassium into the bloodstream, causing hyperkalemia. Together, these create a picture of low circulating volume with elevated potassium, which is a common early finding after a burn. Hyperkalemia alone would miss the fluid loss, and hypokalemia with hypervolemia doesn’t fit the immediate capillary leak and cell damage. Normal electrolytes are unlikely given the rapid fluid shifts and cell injury. Be mindful, though, that later on potassium can drop as fluids are resuscitated and diuresis occurs.