Fluid Replacement for 15% BSA Burns
For an adult with 15% BSA full and partial thickness burns on arms and legs, administer 3-4 mL/kg/%TBSA of Lactated Ringer's solution over 24 hours using the modified Parkland formula, with half given in the first 8 hours post-burn. 1, 2
Initial Fluid Calculation and Administration
Use the modified Parkland formula: 3-4 mL/kg/%TBSA for the first 24 hours. 1, 2, 3
- For a 15% BSA burn, calculate: Patient weight (kg) × 3-4 mL × 15% = total 24-hour fluid volume 1
- Example: A 70 kg patient would receive 3,150-4,200 mL over 24 hours 1
- Administer half of the calculated volume in the first 8 hours post-burn, then the remaining half over the next 16 hours 1, 2, 3
- Use Lactated Ringer's solution as the preferred balanced crystalloid; avoid 0.9% NaCl due to risk of hyperchloremic acidosis 2
Timing Considerations
- Give an initial bolus of 20 mL/kg of balanced crystalloid within the first hour to address early hypovolemic shock, regardless of burn size 2, 3
- Establish IV access immediately, preferably in unburned areas 2, 3
- The clock starts at time of injury, not time of presentation 1, 2
Monitoring Parameters and Titration
Target urine output of 0.5-1 mL/kg/hour as the primary endpoint for adequate resuscitation. 1, 2, 3
- Adjust fluid rates based on urine output—this is the easiest and fastest parameter to monitor 1, 2
- Monitor mean arterial pressure to ensure adequate perfusion 3
- Avoid accepting higher than recommended urine output, as this contributes to "fluid creep" 4
Critical Pitfalls to Avoid
Beware of "fluid creep"—the tendency to over-resuscitate beyond the Parkland formula predictions. 4
- Studies show 76% of resuscitations receive >4.3 mL/kg/%TBSA (the upper Parkland limit), averaging 6.3 mL/kg/%TBSA 4
- Over-resuscitation leads to complications including compartment syndrome, pulmonary edema, and intestinal edema 5, 4
- The primary cause is failure to titrate down fluid infusion rates when urine output exceeds targets 4
- Pre-hospital fluid administration often contributes 40% of the recommended 24-hour Parkland volume before burn center arrival 4
Special Considerations for Full Thickness Burns
- Deeper burns (full thickness) may require volumes at the higher end of the range (4 mL/kg/%TBSA) 1
- Monitor for circumferential burns causing circulatory compromise, which may require escharotomy 2, 3
- Full thickness burns increase risk of wound conversion and delayed healing 5
Pediatric Modifications (if applicable)
- Children require fluid resuscitation for burns ≥10% TBSA (compared to adults who typically need it for ≥15-20% TBSA) 2, 3
- Children have higher body surface area-to-weight ratios and require proportionally more fluid 1, 3