Fluid resuscitation in the burned child--a reappraisal

Recent reports have suggested that burned adults may be resuscitated with one half the volumes of Ringer's lactate recommended by the popular Parkland formula (4 ml/kg/% burn). Forty children studied with a mean burn size of 45% were initially estimated to require 3 ml/kg/% (modified Brooke formula) but the actual requirement was greater. Burns of 25%-35% required 3 ml/kg/% but those in excess of 35% required 4 ml/kg/% or more in order to achieve adequate cardiac output. It is likely that this apparent increased need in children as compared to adults is the result of greater metabolic rate and insensible water loss.