Estimation of fluid requirements

The fluid regimen for major burns recommended by The British Burn Association is guided by the estimate of losses determined by the Parkland Formula. The Parkland Formula cannot be applied without knowledge of the:

• patient's weight in kilograms; either measured directly, taken from the history or estimated
• burn area estimate - see submenu

Hence, the fluid requirements for the first 24 hours in millitres are: (3-4 mls of Hartmann solution multiplied by the weight of the patient in kilograms) multiplied by the total percentage body surface area (TBSA) of the burn. Half of the calculated volume is given in the first eight hours from the time of the burn. The remaining volume is given in the following sixteen hours. The decision to give 3ml or 4ml per kg per %TBSA depends on the setting. The greater estimate of volume is given if there is:

• inhalational injury
• electrical injury with likely deep tissue damage
• a child victim
• prior dehydration e.g. prolonged delay before transfer
• concomitant trauma; major trauma may need blood replacement

In addition, children and adults need maintenance fluids - see submenu. Fluid requirements for the second 24 hour period are detailed in the submenu.

The estimate of fluid requirements are only approximate and close monitoring is vital - see main menu.

The Muir and Barclay Formula provides an alternative estimated volume.