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Difficulty: MediumTrauma and Burns

Paramedics bring a 35-year-old male to the emergency department after he was rescued from a residential fire. The patient weighs 75 kg. According to the paramedics, the burn injury occurred exactly 2 hours prior to arrival. Physical examination reveals deep partial-thickness and full-thickness burns covering his entire posterior trunk and both of his entire upper extremities. The remainder of his skin is intact. Two large-bore intravenous lines are established.

Using the traditional Parkland formula (44 mL/kg/% total body surface area), what should be the intravenous fluid administration rate (in mL/hr) prescribed for the remaining time to complete the first 8-hour post-injury resuscitation goal?

Answer: 900 mL/hr

Answer

900
The traditional Parkland formula is calculated as 44 mL of crystalloid per kg of body weight per percentage of TBSA burned. For this 75 kg patient with 36% TBSA burns (18% for the entire posterior trunk + 9% for each upper extremity), the total 24-hour fluid requirement is 4×75×36=10,8004 \times 75 \times 36 = 10,800 mL. Half of this volume (5,4005,400 mL) must be administered within the first 8 hours from the time of the burn. Because the injury occurred 2 hours prior to arrival, only 6 hours remain in this initial window. Therefore, the 5,4005,400 mL must be infused over 6 hours, requiring a rate of 900900 mL/hr.

Step-by-Step Solution

1
Calculate the burned Total Body Surface Area (TBSA) using the Rule of Nines.
18% (posterior trunk) + 9% (right arm) + 9% (left arm) = 36% TBSA.
The Parkland formula requires an accurate estimation of the total burn surface area.
2
Calculate the total 24-hour fluid resuscitation volume using the traditional Parkland formula.
4 mL/kg × 75 kg × 36% = 10,800 mL.
This establishes the total volume of Lactated Ringer's needed for the first 24 hours after the injury.
3
Determine the fluid volume required for the first 8 hours.
10,800 mL / 2 = 5,400 mL.
Standard burn resuscitation guidelines dictate that 50% of the calculated 24-hour volume is given in the first 8 hours post-injury.
4
Calculate the intravenous fluid rate based on the elapsed time since the injury.
5,400 mL / (8 hours - 2 hours) = 5,400 mL / 6 hours = 900 mL/hr.
The first 8-hour window begins at the time of injury, not at the time of hospital admission. Because 2 hours have already elapsed, the fluid must be infused over the remaining 6 hours.

Key Concept

Burn fluid resuscitation calculations must account for the time elapsed since the injury when setting the infusion rate for the first 8 hours.
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Topics

Trauma and Burns

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