A 35-year-old man with 40% total body surface area burns (TBSA) including face and anterior torso (flame burns) is resuscitated using the Parkland formula. Over the first 24 hours, he receives Lactated Ringer's solution. After 24 hours, his urine output averages 35 mL/hour (target 0.5–1 mL/kg/hour for his 70 kg body weight). Which statement about fluid resuscitation targets in burns best reflects current evidence from the ISBI guidelines?

• A Urine output of 35 mL/hour in a 70 kg patient indicates over-resuscitation; rate should be decreased
• B Urine output 0.5 mL/kg/hour (35 mL/hour for 70 kg) is within the target range; no rate adjustment needed ✓
• C Colloid should be added at 8 hours for full-thickness burns regardless of urine output
• D The Muir and Barclay formula using colloid is superior to Parkland formula in all burns >30% TBSA

Explanation

The Parkland formula (4 mL × weight in kg × %TBSA) gives the total volume for 24 hours; half is infused in the first 8 hours (from time of burn, not arrival), and the remaining half over the next 16 hours. Urine output is the primary resuscitation endpoint; the target is 0.5–1.0 mL/kg/hour in adults (and 1 mL/kg/hour in children). At 70 kg, 35 mL/hour exactly meets the 0.5 mL/kg/hour lower target and is acceptable; no upward adjustment is needed. Infusing above this target risks abdominal compartment syndrome ('fluid creep'). Colloid addition at 12–24 hours is evidence-supported in some protocols to reduce total crystalloid volume but is not universally mandatory.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.