If burn area is 70%what will b d fluid required
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Here is a complete breakdown of fluid resuscitation for a 70% TBSA burn:
Fluid Resuscitation for 70% TBSA Burn
The Parkland (Baxter) Formula - Most Commonly Used
Total fluid = 4 mL x kg body weight x % TBSA burned Fluid used: Lactated Ringer's (LR)
| Body Weight | Calculation | Total Fluid (24 hrs) |
|---|---|---|
| 50 kg | 4 x 50 x 70 | 14,000 mL (14 L) |
| 60 kg | 4 x 60 x 70 | 16,800 mL (16.8 L) |
| 70 kg | 4 x 70 x 70 | 19,600 mL (19.6 L) |
| 80 kg | 4 x 80 x 70 | 22,400 mL (22.4 L) |
Delivery Schedule (Critical)
- First 8 hours from time of burn: give 1/2 of total volume
- Next 16 hours: give remaining 1/2 of total volume
Note: The 8-hour countdown starts from the time of injury, not from when IV access is obtained. If there is a delay, the rate must be increased to compensate.
Other Formulas for Comparison
| Formula | First 24 Hours | Fluid Type |
|---|---|---|
| Parkland | 4 mL/kg/% TBSA | LR (all) |
| Modified Parkland | 3-4 mL/kg/% TBSA | LR |
| Modified Brooke | 2 mL/kg/% TBSA | LR |
| ABA Consensus (adults) | 2 mL/kg/% TBSA | LR |
| Evans | 1 mL/kg/% TBSA crystalloid + 1 mL/kg/% TBSA colloid | Mixed |
The American Burn Association (ABA) now recommends 2 mL/kg/% TBSA as the starting point due to the tendency for over-resuscitation with the traditional Parkland formula. Studies show patients typically end up receiving 4.6-6.3 mL/kg/% TBSA instead of the recommended 4 mL - increasing the risk of complications.
Second 24 Hours
- Colloid (albumin 5%) is typically added: 0.3-0.5 mL/kg/% TBSA
- Free water (D5W) is added to replace evaporative losses
- IV LR is reduced or stopped as capillary leak resolves
Monitoring Endpoints
| Parameter | Target |
|---|---|
| Urine output (adults) | 30-50 mL/hour |
| Urine output (children) | 1-1.5 mL/kg/hour |
| Mean arterial pressure | >60 mmHg |
| Serum lactate | Normalizing trend |
Special Considerations for 70% TBSA Burns
- This is a massive burn with very high mortality. Over-resuscitation ("fluid creep") is a real risk - it can lead to abdominal compartment syndrome, pulmonary edema, and extremity compartment syndromes.
- If inhalation injury is present, fluid needs increase significantly - studies show an average of 5.76 mL/kg/% TBSA is needed vs. 3.98 mL without inhalation injury.
- All formulas are starting points only - fluid must be titrated continuously based on clinical response (urine output and MAP).
- Children (<20 kg) also need glucose-containing maintenance fluid in addition to LR resuscitation.
Sources: Rosen's Emergency Medicine, Table 54.3; Schwartz's Principles of Surgery, 11th ed.
Some book say if body weight more than 50% we assume as 50 weight is that correct
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burn fluid resuscitation Parkland formula TBSA capped at 50 percent rule
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Great question - this is a common point of confusion. Let me clarify exactly what gets capped:
What Gets Capped at 50% - TBSA, Not Body Weight
You are partially right, but the rule applies to % TBSA burned, NOT body weight:
If TBSA burn > 50%, use 50% in the formula (not the actual %)
So for your 70% TBSA burn case:
| Without cap | With 50% cap | |
|---|---|---|
| Formula | 4 x 70 kg x 70% | 4 x 70 kg x 50% |
| Result | 19,600 mL | 14,000 mL |
Why? Beyond 50% TBSA, capillary leak doesn't increase proportionally. Using the actual % leads to dangerous over-resuscitation ("fluid creep"), which can cause abdominal compartment syndrome and pulmonary edema.
What About Body Weight?
The body weight issue comes up separately - specifically in obese patients:
- Using actual body weight in obese patients can cause massive over-resuscitation
- Some centers use ideal body weight (IBW) for obese patients instead of actual weight
- However, Miller's Anesthesia notes: "It remains unclear as to whether actual or ideal body weight is appropriate... actual body weight and TBSA provide a reasonable starting point, after which fluid rates should be reduced hourly."
There is no standard rule to cap body weight at 50 kg universally. If you saw this in a specific textbook, it may be a simplified teaching guideline for that institution or exam context - but it is not a widely endorsed clinical standard.
Summary
| Rule | What is capped | Value |
|---|---|---|
| TBSA cap | % burn area | Cap at 50% if actual burn >50% |
| Obesity adjustment | Body weight | Use IBW (no fixed cap - varies by guideline) |
The "50 kg weight" rule you mentioned is not standard in major references. The well-established rule is capping %TBSA at 50%, not body weight at 50 kg.
I mean if burn% is more than 50 than we assume as 50%burn
Yes, that is exactly correct! And I already confirmed this in my previous answer. Let me summarize it clearly:
TBSA Cap Rule - Confirmed
If % TBSA burn > 50%, use 50% in the Parkland formula
This is a recognized teaching rule used to prevent over-resuscitation.
So for your original question (70% TBSA burn):
| Step | Value |
|---|---|
| Actual TBSA | 70% |
| TBSA used in formula | 50% (capped) |
| Body weight (e.g. 70 kg) | 70 kg |
| Formula | 4 x 70 x 50 |
| Total fluid in 24 hrs | 14,000 mL (14 L) |
Delivery:
- First 8 hours - 7,000 mL (from time of injury)
- Next 16 hours - 7,000 mL
Why this rule exists:
- Beyond 50% TBSA, the capillary leak and fluid shift do not increase proportionally
- Using the actual % (70%, 80%, 90%) would give dangerously large volumes
- This leads to "fluid creep" - causing pulmonary edema, abdominal compartment syndrome, and limb compartment syndrome
So yes - your book is correct. For any burn >50% TBSA, plug in 50% into the Parkland formula, not the actual percentage.
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