Fluid Resuscitation…It’s all in the Numbers

Fluid resuscitation is a critical component in the outcome of the burn patient. During the first 24 hours
postburn injury, the patients develop a capillary permeability which allows fluid to leak from the
vascular system into interstitial space resulting in increased edema and decreased vascular volume. The
goal of proper resuscitation is to maintain tissue and organ perfusion. Providing inadequate fluids in the
initial postburn hours leads to increased mortality and morbidity; however , over-resuscitating or giving
too much fluid can be just as detrimental.

The American Burn Association’s Advanced Burn Life Support (ABLS) 2010 Fluid Resuscitation Formula
helps to address the tendency to accidentally over-resuscitate the burn patient in the first 24 hours.
The guidelines have recommended rates of lactated ringers that are to be started during the initial/pre-
hospital primary survey. This allows the providers to start the needed fluids at a rate that will not be
detrimental to the patient and allows time to complete both the primary and secondary survey and
calculate the total body surface area (TBSA) injured, followed by a more accurate calculation of the
fluid needs per the formula.

Initial Pre-hospital Fluid Rates:

• 5 years old and younger: 125 mL lactated Ringers/hour
• 6-13 years old: 250 mL lactated Ringers/hour
• 14 years and older: 500 mL lactated Ringers/hour

ABLS 2010 Fluid Resuscitation Formula:

• Adult Thermal and Chemical Burns
2 mL LR x body weight in kg x percentage 2⁰ & 3⁰ burns = 24- hour postburn total
• Pediatric Patients (14 years and under and less than 40 kgs)
3 mL LR x body weight in kg x percentage 2⁰ & 3⁰ burns = 24- hour postburn total
• Adult Patients with High Voltage Electrical Injuries
4 mL LR x body weight in kg x percentage 2⁰ & 3⁰ burns = 24- hour postburn total
Half of the 24 hour estimated total is infused over the first eight hours post burn, and the remaining
half of the estimated volume is infused over the subsequent 16 hours. The volume of fluid that is
actually infused is based on the patient urinary output and clinical response to achieve a urinary output
goal rate of 30-50 mL/hr or 0.5 mL/kg/hr in adults and 1mL/hr in pediatric patients. For adults with
high voltage electrical injury, keep urine output 75-100 mL/hr.

Kayla S Northrop, RN BSN CCRN

Burn Center Unit Educator