Burns fluid replacement

A 55-year-old, 75 kg male sustains 40% body surface area (BSA) burns in a house fire.

Using the Parkland formula, in addition to maintenance fluids, the extra intravenous

fluid he should receive in the first eight hours following injury is:

a) 3000mL of crystalloid

b) 3000mL of colloid

c) 750mL colloid and 2250mL of crystalloid

d) 4000mL of crystalloid

e) 6000mL of crystalloid

Answer: e

Explanation

The Parkland formula only involves crystalloid. It is simply 4 mL/kg×%BSA over

24 hours. Half is given over eight hours, the rest over the next 16 hours. In this case

4×75×40 = 12 000mL in 24 hours with 6000mL in the first eight hours following injury

(not following admission).

Hartmann’s solution is favoured over 0.9% saline to avoid the hyperchloraemic

metabolic acidosis associated with large volumes of saline. The Brook formula uses

0.5 mL/kg×%BSA of colloid and 1.5 mL/kg×%BSA of crystalloid in the first

24 hours, again half in eight hours and the rest over 16 (as for Option (c)). The Muir

Barclay (Mount Vernon) formula uses colloid aliquots of 0.5 mL/kg×%BSA over

durations of four, four, four, six and six hours (as for Option (b)).

It should be remembered that these formulae are in addition to maintenance

requirements and are a guide only. Fluid management in burns is based on frequent

clinical assessment and measurements along with laboratory investigations (including

four-hourly electrolytes, haematocrit, urine and plasma osmolality).