What is the fluid requirement for a burn patient with 14.5% TBSA?

Fluid Resuscitation for 14.5% TBSA Burn

For a burn patient with 14.5% TBSA, initiate fluid resuscitation using the Parkland formula: 4 mL/kg × body weight (kg) × % TBSA burned, with half administered in the first 8 hours and the remainder over the subsequent 16 hours. 1

When to Initiate Fluid Resuscitation

• Adults with burns >15% TBSA require formal fluid resuscitation 1
• Since this patient has 14.5% TBSA, they fall just below the typical threshold for adults, but clinical judgment should guide initiation based on signs of hypovolemia or shock 2
• Children with burns >10% TBSA should receive fluid resuscitation 1
• If this is a pediatric patient, fluid resuscitation is mandatory given the 14.5% TBSA 1

Parkland Formula Calculation

For this specific case with 14.5% TBSA:

• Total 24-hour fluid requirement = 4 mL/kg × [patient weight in kg] × 14.5
• First 8 hours: Give 50% of calculated volume (2 mL/kg × weight × 14.5)
• Next 16 hours: Give remaining 50% of calculated volume 3

Example: For a 70 kg adult:

• Total = 4 × 70 × 14.5 = 4,060 mL over 24 hours
• First 8 hours: 2,030 mL
• Next 16 hours: 2,030 mL

Fluid Type and Monitoring

• Use lactated Ringer's solution as the crystalloid of choice 3
• Time calculation from the moment of burn injury, not from hospital arrival 3
• Target urine output of 0.5-1.0 mL/kg/hour in adults to guide adequacy of resuscitation 4
• Avoid hyperdynamic resuscitation strategies that aim for supranormal cardiac output, as these provide no benefit and may cause fluid overload 4

Critical Pitfalls to Avoid

• Do not overestimate TBSA using the Rule of Nines, which overestimates in 70-94% of cases 1
• Use the Lund-Browder chart for accurate TBSA assessment, as it is the reference standard and accounts for age-related body proportion differences 1
• Overestimation of TBSA leads to excessive fluid administration and complications including pulmonary edema 1
• Monitor for fluid overload: excessive resuscitation can cause pulmonary, cutaneous, and intestinal edema 2

Special Considerations for Burns Near 15% TBSA Threshold

• Burns at 14.5% TBSA in adults represent a borderline indication where clinical assessment is paramount 2
• Consider initiating resuscitation if patient shows signs of hypovolemia, has inhalation injury, or has other comorbidities 2
• Reassess TBSA calculation using Lund-Browder chart as initial estimates are frequently inaccurate 1, 5
• Burns may evolve in appearance and depth during initial management, requiring repeated assessment 1

Transfer Considerations

• Adults with burns >10% TBSA should be considered for burn center referral 1, 3
• This 14.5% TBSA burn meets criteria for burn center consultation 3
• Do not delay transfer for extensive diagnostic workup 6