In this article, we will discuss Formulas Used for Fluid Management in Major Burns. So, let’s get started.
Formulas Used for Fluid Management in Major Burns
The most commonly used formulas are the Parkland, modified Parkland, Brooke, modified Brooke, Evans and Monafo’s formulas. These formulas take into account the body weight and the burn surface area as the volume is relatively constant in proportion to the area of the body burned.
a. Initial 24 hours: Ringer’s lactate (RL) solution 4 ml/kg/% burn for adults and 3 ml/kg/% burn for children. RL solution is added for maintenance for children:
• 4 mL/kg/hr for children weighing 0-10 kg
• 40 mU/hr +2 ml/hour for children weighing 10-20 kg
• 60 mL/hr + 1 ml/kg/hr for children weighing 20 kg or higher
This formula recommends no colloid in the initial 24 hours
b. Next 24 hours: Colloids given as 20-60% of calculated plasma volume. No crystalloids. Glucose in water is added in amounts required to maintain a urinary output of 0.5-1 mL/hr in adults and 1 ml/ hour in children.
Modified Parkland Formula
a. Initial 24 hours: RL 4 ml/kg/% burn (adults)
b. Next 24 hours: Begin colloid infusion of 5% albumin 0.3-1 ml/kg/% burn/16 per hour
a. Initial 24 hours: RL solution 1.5 ml/kg/% burn plus colloids 0.5 ml/kg/% burn plus 2000 mL glucose in water.
b. Next 24 hours: RL 0.5 ml/kg/% burn, colloids 0.25 ml/kg/% burn and the same amount of glucose in water as in the first 24 hours.
a. Initial 24 hours: No colloids. RL solution 2 mL/kg/% burn in adults and 3 ml/kg/% burn in children
b. Next 24 hours: Colloids at 0.3-0.5 ml/kg/% burn and no crystalloids are given. Glucose in water is added in the amounts required to maintain good urinary output.
Evans Formula (1952)
a. First 24 hours: Crystalloids 1 ml/kg/% burn plus colloids at 1 ml/kg/% burn plus 2000 mL glucose in water.
b. Next 24 hours: Crystalloids at 0.5 mL/kg/% burn, colloids at 0.5 mL/kg/% burn and the same amount of glucose in water as in the first 24 hours.
Monafo recommends using a solution containing 250 mEq Na, 150 mEq lactate and 100 mEq Cl. The amount is adjusted according to the urine output. In the following 24 hours, the solution is titrated with 1/3 normal saline according to urinary output.