Formula

Fluid
in First 24 Hours

Crystalloid in 2^{nd} 24Hours

Colloid in 2^{nd} 24Hours

Brooke (Yowler, 2000)

RL at 1.5 mL/kg per percentage burn, colloid at 0.5 mL/kg
per percentage burn,
 add 2000 mL D5W

50% of first 24hour volume 
add
2000 mL D5W

50% of first 24hour volume

Modified Brooke

RL at 2 mL/kg per percentage burn



Evans (Yowler, 2000)

NS at 1 mL/kg per percentage
burn, 2000 mL D5W*, and colloid at 1 mL/kg per percentage burn

50% of first 24hour volume and add 2000 mL D5W

50% of first 24hour volume

Monafo hypertonic
Demling 
250 mEq/L saline titrated to urine output at 30 mL/h,
dextran 40 in NS at 2 mL/kg/h for 8 hours, RL titrated to urine output at 30
mL/h, and fresh frozen plasma 0.5 mL/h for 18 hours beginning 8 hours post
burn

Onethird NS titrated to urine output


Metro Health
(Cleveland) 
RL solution with 50 mEq sodium bicarbonate per liter at 4
mL/kg per percentage burn

Half NS titrated to urine output

1 U fresh frozen plasma for each liter of half NS used
and add
D5W as needed for
hypoglycemia

Slater (Yowler, 2000)

RL at 2 L/24 h and
add fresh frozen plasma at 75 mL/kg/24
h



Wednesday, April 16, 2014
Burns treatment, resuscitation in burns, formula, managing burn patients…..
Doc, you described the fluid requirement in the first 24 hrs, what
happens in the next 24 hrs? How do we calculate the fluid requirements for
that?
One more question you gave a few formulas for the burn calculation,
could you outline some more?
Surya, N Delhi, India
The formula for fluid resuscitation
help to calculate the fluid requirements for the first 24 hours. It is during
this period that the critical fluid displacements and loss occur. Loss of body
fluids from the burn surface area as well as the leaking of intravascular
fluids into the extracellular spaces account for the fluid loss that occur in
burn patients. However the body regains its capacity to maintain its intravascular
volume by avoiding the leaking of plasma proteins and in fact by the 2^{nd}
24 hours after the burn, the fluids from the extra vascular spaces start
getting reabsorbed. Therefore at this stage it is not necessary to administer a
lot of fluids as we do in the first 24 hours. During the second 24 hours the
fluids are calculated from the normal daily requirements as any surgical
patient and additional fluids are given to maintain the clinical parameters
like the pulse, blood pressure and urine output (half ml/kg/hr in adults and
one ml/kg/hr in children) as outlined in a previous post.
Some formulas advice cutting down the
fluids to be administered in the 2^{nd} 24 hours to half that of the
first 24 hours. This again is a guideline and one must not forget that the
resuscitation process is a continuous process and no sudden changes must be
attempted in fluid administered which must be very gradually reduced depending
on the clinical parameters and patient response unless the patient is in shock
or with volume overload.
The parkland formula has been
described before in detail. Some of the other resuscitation formulas which were
not mentioned in our previous articles are outlined below:
Resuscitation Formulas in burn patients
*D5W is
dextrose 5% with water
(An original initiative in burn care and education from asktheburnsurgeon++)+
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Burn injuries are unbearably painful. I remember once I got burn injury when I was working at a workplace. Had I taken safety precaution I would have not met that accident in the first place.
ReplyDeleteRegards,
Arnold Brame
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ReplyDeleteInteresting blog and I really like your work and must appreciate you work for the ask a doctor it's nice work.
ReplyDeleteask a doctor