A 30-year-old man sustains 40% TBSA burns (30% full thickness) in a house fire. The Parkland formula for the first 24 hours recommends which fluid regimen, and how should it be distributed over the 24-hour period?
- A 4 mL/kg/% TBSA of Ringer's lactate; half in first 8 hours, half in next 16 hours ✓
- B 2 mL/kg/% TBSA of normal saline; one-third each 8-hour period
- C 4 mL/kg/% TBSA of colloid; administered over 24 hours equally
- D 3.5 mL/kg/% TBSA of 5% dextrose saline; half in first 12 hours
Correct answer: A. 4 mL/kg/% TBSA of Ringer's lactate; half in first 8 hours, half in next 16 hours
Explanation
The Parkland (Baxter) formula calculates 4 mL × body weight (kg) × TBSA burned (%) of Hartmann's/Ringer's lactate in the first 24 hours from time of burn (not from time of admission). Half is given in the first 8 hours and the remaining half over the next 16 hours, adjusted by urine output (target 0.5–1 mL/kg/hr in adults). Colloids are generally avoided in the first 24 hours as the capillary leak allows them to extravasate. Time is calculated from time of burn.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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