When calculating fluid requirements in children with burns...

When calculating fluid requirements in children with burns, which ONE of the following statements is correct?
A. 4 mL/kg × % of total body surface area affected should be given within the first 8 hours
B. 0.9% sodium chloride is the preferred intravenous fluid
C. Maintenance requirements are given in addition to resuscitation fluid
D. The volume of resuscitation fluid required is determined by the depth of the burn
E. Urine output is a poor way to monitor adequacy of fluid replacement

Answer:
C. Maintenance requirements are given in addition to resuscitation fluid

Discussion: Burn injuries produce both local and systemic reactions. In small burns, the body’s response is localized to the site of the burn. In larger burns affecting over 30% of the total body surface area, and also in deeper dermal burns, a systemic inflammatory response is seen with inflammatory mediators such as cytokines, prostaglandins, histamine and complement being released into the circulation.

The heterogeneous nature of children with burns, in terms of their varying size and burn area, has led to the exploration of a number of formulae to guide fluid resuscitation. The most widely accepted version is the Parkland formula:

Volume required over first 24 hours in mL = 4 × % body surface area of burn × body weight

50% of this volume is administered over the first 8 hours with the remainder administered over the subsequent 16 hours.

The recommended fluid is crystalloid and, in general, Hartmann’s solution is used as this has the closest electrolyte composition to plasma.

Maintenance fluid requirements should be administered in addition to these volumes.