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Fluid resuscitation: It’s all in the numbers

Fluid resuscitation is critical for burn patients. During the first 24 hours after injury, burn patients' capillaries become permeable. This allows fluid to leak from the vascular system into interstitial space, resulting in increased edema and decreased blood volume. Proper resuscitation helps maintain tissue and organ perfusion.

ABLS guidelines recommend rates of lactated ringers (solution) to start during the initial/prehospital primary survey.

Controlled fluid resuscitation directs providers to begin giving fluids at a rate that won’t harm the patient. It also allows time to calculate the extent of injury and follow the formula’s fluid guidelines.

Burn fluid resuscitation formulas

Prehospital pediatric rates
  • Up to 5 years old: 125 mL LR/hour
  • 6-13 years old: 250 mL LR/hour
  • 14 years and older: 500 mL LR/hour
Adult and pediatric rates for the first 24 hours postburn
  • Adult thermal and chemical burns:
    2 mL LR x body weight in kg x percentage 2nd and 3rd degree burns
  • Pediatric patients (age 14 and under; weighing < 40 kgs):
    3 mL LR x body weight in kg x percentage 2nd and 3rd degree burns
  • Adult patients with high-voltage electrical injuries:
    4 mL LR x body weight in kg x percentage 2nd and 3rd degree burns