Is the Parkland formula (Parkland formula for burn patient fluid resuscitation) used for electric burns?

Parkland Formula for Electrical Burns

The Parkland formula should not be used as the primary fluid resuscitation guide for electrical burns, as it is designed for thermal burns and does not account for the unique pathophysiology of electrical injuries. 1

Fluid Resuscitation in Electrical Burns vs. Thermal Burns

Electrical burns differ significantly from thermal burns in several important ways:

• Electrical burns cause deeper tissue damage than is apparent on the skin surface
• They often result in rhabdomyolysis (muscle breakdown) with myoglobinuria
• The visible burn area (TBSA) often underestimates the actual tissue damage

Why Parkland Formula Is Inadequate for Electrical Burns

The Parkland formula (4 mL/kg/%TBSA) was designed for thermal burns and relies on accurate TBSA assessment, which is problematic in electrical injuries where:

1. The visible burn area doesn't correlate with the extent of deep tissue damage
2. Muscle destruction requires additional fluid beyond what Parkland would calculate
3. Myoglobinuria requires higher urine output targets than standard burn resuscitation

Appropriate Fluid Management for Electrical Burns

According to current guidelines, fluid management for electrical burns should:

• Begin with balanced crystalloids (Lactated Ringer's solution) at higher initial rates than Parkland would suggest 1
• Target higher urine output of 1-2 mL/kg/hour (compared to 0.5-1 mL/kg/hour for thermal burns) when myoglobinuria is present 1
• Avoid potassium-containing solutions like Hartmann's in patients with crush syndrome or rhabdomyolysis 1
• Include additional monitoring parameters beyond urine output, such as arterial lactate concentration and hemodynamic parameters 1

Clinical Approach to Electrical Burn Resuscitation

1. Initial fluid bolus with balanced crystalloids (15-20 mL/kg in first hour)
2. Adjust fluid rates based on:
   • Urine output (target 1-2 mL/kg/hour for myoglobinuria)
   • Serum lactate levels
   • Hemodynamic parameters
   • Signs of compartment syndrome

Common Pitfalls in Electrical Burn Management

• Underestimating fluid needs by relying on visible burn area
• Failing to recognize and treat rhabdomyolysis
• Inadequate monitoring of compartment syndrome
• Using potassium-containing fluids when rhabdomyolysis is present
• Delaying transfer to specialized burn centers

Special Considerations

• Monitor for intra-abdominal hypertension, which may require escharotomy within 48 hours 1
• Consider early transfer to specialized burn centers for electrical injuries 1
• Implement multimodal analgesia immediately, as electrical burns can be extremely painful 1

While the Parkland formula provides a useful starting point for thermal burns, it fails to address the complex fluid requirements of electrical injuries, where fluid needs are often significantly higher and must be guided by clinical parameters rather than formula calculations.