Fluid Resuscitation in Burn Patients

It is important to start IV fluid resuscitation of a burn patient early.  The fluid requirement is based on the percent of their total body surface area (TBSA) that is burned and their weight.

How do we know what percent TBSA is burned?

A quick rule of thumb is the "Rule of Nines" -

from emedicinehealth.com

Basically, the body is divided into 11 regions of 9% each -

Entire head

Anterior chest

Anterior abdomen

Posterior chest

Posterior abdomen

Each arm

Each anterior leg

Each posterior leg

The additional 1% is the perineum

In infants, the percentages change a little because the head is 18% - the lower extremities are less

An important note is that TBSA is only calculated for partial and full thickness burns - a "first-degree" burn only involves the epithelium and does not need to be factored in.

Another method of estimating small or irregular burns is to consider the size of the patient's palm as 1%.

Once we know the TBSA and the patient's weight (in kg) we plug it into the Parkland formula:

TBSA x weight x 4ml = 24 hour fluid requirements

One-half of this fluid is given over the first 8 hours following the burn, the other half is given over the remaining 16 hours.

An example -

100 kg male sustains a 40% burn -

40 x 100 x 4 = 16000

the patient needs 16 liters of fluid, 8 liters in the first 8 hours or 1 liter per hour, followed by 8 liters in the next 16 hours or 500 ml/hour.

We usually start with Lactated Ringers' solution.  The clock starts at the time of burn.

This is only an estimate, so it is important to follow the patient's urine output to assure they are being adequately resuscitated.  If the urine output remains low, the patient should be examined to assure that the burn hasn't been underestimated, there isn't an associated compartment syndrome, or that there isn't a large inhalation component which will increase the fluid requirements.