Adults with burns >15% TBSA and children with burns >10% TBSA require fluid resuscitation. There are a number of methods to calculate appropriate fluid requirements. The most frequently used is the Parkland formula21:

2-4ml x weight in kg x %TBSA

  • This estimates the total resuscitation fluid required over 24 hours from the time of the burn
  • This is in addition to the usual maintenance fluid requirement
  • Usually 3ml is used for the calculation
  • 2ml might be considered in children or those at risk of complication from fluid overload
  • 4ml might be considered in inhalational injuries where fluid losses are likely to be greater
  • Half of the calculated volume should be administered within the first 8 hours from the time of the burn
  • The remaining half should be administered over the subsequent 16 hours
  • The optimal fluid choice is warmed balanced crystalloid, such as Hartmanns Solution or Plasmalyte
  • Urine output should be monitored closely and input titrate to achieve an output of >0.5mg/kg/hr in adults and >1ml/kg/hr in children <30kg
  • Urine output targets should be doubled if rhabdomyolysis is suspected