Fluid Resuscitation Targeting Urine Output 0.5-1 mL/kg/hr
This patient requires fluid resuscitation targeting a urine output greater than 0.5 mL/kg/hr (Option A). 1
Burn Assessment and Fluid Resuscitation Requirements
This patient has partial-thickness burns (extending through epidermis to dermis) involving:
- Both arms (approximately 18% TBSA)
- Anterior chest (approximately 9% TBSA)
- Abdomen (approximately 9% TBSA)
- Total estimated TBSA: ~36%
Any adult with burns ≥10% TBSA requires formal fluid resuscitation. 2 This patient clearly exceeds this threshold and needs aggressive fluid management.
Initial Fluid Resuscitation Protocol
Immediate first hour: Administer 20 mL/kg of balanced crystalloid solution (preferably Ringer's Lactate) within the first hour. 1, 2
24-hour fluid calculation: Use the Parkland formula (2-4 mL/kg/%TBSA burned). 2 For this patient with approximately 36% TBSA:
- Give half of the calculated 24-hour requirement in the first 8 hours post-burn
- Give the remaining half over the next 16 hours 2
Monitoring and Titration Strategy
The easiest and fastest way to adjust fluid resuscitation rates is based on hourly urine output, with a target of 0.5-1 mL/kg/h commonly used in adults with thermal burns. 1 This is the standard monitoring parameter that guides ongoing fluid administration. 2
Additional monitoring parameters may include:
- Arterial lactate concentration
- Advanced hemodynamic monitoring (echocardiography, cardiac output monitoring) particularly valuable in patients with hemodynamic instability or persistent oliguria despite resuscitation 1
Why the Other Options Are Incorrect
Option B (30 mL/kg bolus): This represents a generic sepsis resuscitation protocol, not the specific burn resuscitation strategy. Burns require calculated, sustained fluid administration based on TBSA and weight, not a single bolus approach.
Option C (STAT echocardiogram): Echocardiography is reserved for patients with persistent hypotension despite appropriate fluid resuscitation or hemodynamic instability. 1 It is not a first-line requirement for stable burn patients.
Option D (Intubation): There is no indication for immediate intubation based on the information provided. Intubation would be indicated for:
- Inhalation injury (circumoral burns, oropharyngeal burns, carbonaceous sputum) 2
- Respiratory compromise
- Circumferential thoracic burns causing ventilatory compromise 1
None of these are mentioned in this case.
Critical Pitfalls to Avoid
Avoid "fluid creep" (excessive fluid administration beyond calculated requirements), as both under-resuscitation and over-resuscitation are associated with increased morbidity. 1, 2 The urine output target of 0.5-1 mL/kg/hr provides the objective measure to prevent both extremes.
Use balanced crystalloid solutions (Ringer's Lactate), not 0.9% NaCl, as normal saline is associated with higher risk of hyperchloremic metabolic acidosis and acute kidney injury. 1, 2
Monitor for compartment syndrome given the circumferential nature of arm burns, which may require escharotomy if circulatory compromise develops. 2, 3