Burn resuscitation: Parkland formula, endpoints, and fluid creep

Model answer

Calculation (5). 4 × 70 × 40 = 11,200 mL in 24 h of Hartmann or lactated Ringer; half 5,600 mL in the first 8 h from injury, so 6 h remain on arrival at 2 h; second half over the next 16 h; modern programmes initiate lower at 2 mL per kg per percent TBSA per the ABA guideline and titrate.^[6][5][7]

Endpoints (5). Adult urine output about 30 to 35 mL/h for an average adult; titrate hourly and reduce the rate for polyuria; co-oximetry if smoke exposure (taught); no suxamethonium — contraindicated in thermal trauma with potassium efflux from days to months.^[9][6][10]

Fluid creep (5). Fluid far beyond the formula's prediction — largely progressive oedema in unburned areas after the first 8 hours — linked to abdominal compartment syndrome and serious complications; control by avoiding early overresuscitation, colloid rescue, and protocolised titration.^[6]