Figure 1

Time course of fluid resuscitation for a 6 year-old boy (20 kg) with 33% TBSA scald burns. He arrived at the burn center 6 hours post-injury, having received 900 ml of lactated Ringer's solution prior to arrival. Fluid resuscitation was started according to the Parkland forumula (heavy dashed line); nurses were instructed to maintain urine output between 0.9 and 1.8 ml/kg/h (dotted line). Initial resuscitation was close to Parkland guidelines, but beginning at about 10 hours post-burn, fluid requirements increased progressively until about 22 hours post-burn, when urine output finally began to rise, and fluids were tapered in a stepwise manner according to protocol. The patient reached his calculated maintenance fluid rate of 106 ml/h at hour 36. Total resuscitation received was 11.38 ml/kg/% TBSA. He had no difficulties with compartment syndromes or respiratory distress.