What is the most appropriate initial fluid resuscitation formula for a child with a partial thickness burn covering 15% of the total body surface area (TBSA)?

Fluid Resuscitation for a 5-Year-Old Child with 15% TBSA Burn

The most appropriate initial fluid resuscitation formula for a 5-year-old child with a 15% TBSA deep partial thickness burn is 4 mL/kg/%TBSA of Lactated Ringer's over 24 hours (option D). 1

Rationale for Fluid Resuscitation in Pediatric Burns

• Fluid resuscitation is a cornerstone in the initial management of severe burns, particularly for children with burns covering ≥10% TBSA 1
• Children differ from adults in having a higher body surface area/weight ratio, making adult formulas inadequate for pediatric patients 1
• Burned children typically require higher total fluid intake than adults in the first 48 hours, with retrospective studies showing approximately 6 mL/kg/%TBSA over that period 1

Appropriate Fluid Resuscitation Formula for This Case

• For children with burns >10% TBSA, the modified Parkland formula using 3-4 mL/kg/%TBSA is recommended 1
• The higher end of this range (4 mL/kg/%TBSA) is appropriate for this child with a deep partial thickness burn 1
• This should be administered as Lactated Ringer's solution, which is the preferred balanced crystalloid solution for burn resuscitation 1

Implementation of Fluid Resuscitation

• Half of the calculated 24-hour fluid requirement should be given in the first 8 hours post-burn, with the remaining half administered over the next 16 hours 1
• For this 5-year-old child with 15% TBSA burn, the formula would calculate as: weight (kg) × 4 × 15% TBSA = total fluid volume for 24 hours 1
• Intravenous access should be obtained as soon as possible, preferably in unburned areas 1

Monitoring and Adjustment

• The initial fluid rate should be adjusted based on clinical and hemodynamic parameters 1
• Urine output is the easiest and fastest parameter to monitor, with a target of 0.5-1 mL/kg/hour in children 1
• Inadequate fluid resuscitation can lead to burn shock, while excessive fluid administration ("fluid creep") can cause complications including compartment syndromes 1

Common Pitfalls to Avoid

• TBSA is frequently overestimated at referring institutions, which can lead to overresuscitation 2
• Option B (2 mL/kg/hour regardless of burn size) fails to account for the extent of the burn and would likely result in inadequate resuscitation 1
• Option E (no fluid resuscitation for burns <20% TBSA) is incorrect as children require fluid resuscitation for burns ≥10% TBSA 1
• Option A (2 mL/kg/%TBSA) would provide insufficient fluid volume for a child with a deep partial thickness burn 1
• Option C (3 mL/kg/%TBSA) falls within the recommended range but may be inadequate for deeper burns 1

The evidence strongly supports using 4 mL/kg/%TBSA of Lactated Ringer's solution over 24 hours as the most appropriate initial fluid resuscitation formula for this pediatric burn patient, with ongoing adjustments based on clinical response 1.