Fluids
Adults with burns >15% TBSA and children with burns >10% TBSA require fluid resuscitation. There are a number of methods to calculate appropriate fluid requirements. The most frequently used is the Parkland formula21:
2-4ml x weight in kg x %TBSA
- This estimates the total resuscitation fluid required over 24 hours from the time of the burn
- This is in addition to the usual maintenance fluid requirement
- Usually 3ml is used for the calculation
- 2ml might be considered in children or those at risk of complication from fluid overload
- 4ml might be considered in inhalational injuries where fluid losses are likely to be greater
- Half of the calculated volume should be administered within the first 8 hours from the time of the burn
- The remaining half should be administered over the subsequent 16 hours
- The optimal fluid choice is warmed balanced crystalloid, such as Hartmann’s Solution or Plasmalyte
- Urine output should be monitored closely and input titrate to achieve an output of >0.5mg/kg/hr in adults and >1ml/kg/hr in children <30kg
- Urine output targets should be doubled if rhabdomyolysis is suspected