What is the fluid requirement of a 50-kg man with firstdegree burns to his left arm and leg, circumferential second-degree burn to his right arm, and third-degree burns to his torso and right leg.
What is the rate of initial fluid resuscitation?
A. 4.5 L over 8 hours, followed by 4.5 L over 16 hoursThe most commonly used formula, the Parkland or Baxter formula, consists of 3 to 4 mL/kg/% burn of lactated Ringer solution, of which half is given during the first 8 hours postburn, and the remaining half over the subsequent 16 hours. The concept behind continuous fluid requirements is simple. The burn (and/or inhalation injury) drives an inflammatory response that leads to capillary leak; as plasma leaks into the extravascular space, crystalloid administration maintains the intravascular volume. Therefore, if a patient receives a large fluid bolus in a prehospital setting or emergency department that fluid has likely leaked into the interstitium and the patient still requires ongoing burn resuscitation according to the estimates. Continuation of fluid volumes should depend on the time since injury, urine output, and mean arterial pressure. As the leak closes, the patient will require less volume to maintain these two resuscitation end points.