Fluids

Adults with burns >20% TBSA and children with burns >10% TBSA (>20% on some guidelines)¹⁴ require fluid resuscitation. There are a number of methods to calculate appropriate fluid requirements. The most frequently used is the Parkland formula¹⁵:

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.