A patient with 40% total body surface area burn arrives in the emergency unit. The nurse prepares to calculate fluid resuscitation using the Parkland formula. Which fluid is commonly used?

1. A

   5% Dextrose

2. B

   Ringer lactate

3. C

   3% saline

4. D

   Albumin

Appeared in: AIIMS Delhi NO- 2019

Explanation

• Ringer lactate is the crystalloid fluid of choice for burn resuscitation as per the Parkland formula.
• It is an isotonic solution, meaning its salt concentration is similar to that of blood plasma, which helps to effectively expand the intravascular volume without causing major fluid shifts.
• The lactate in the solution is metabolized by the liver into bicarbonate, which helps to correct the metabolic acidosis commonly seen in severe burn injuries.

Why Other Options Were Wrong

• Option A: This is a hypotonic solution once the dextrose is metabolized. It does not effectively stay in the vascular space and can lead to cellular swelling and hyponatremia, making it unsuitable for resuscitation.
• Option C: This is a hypertonic solution used in specific critical situations like severe, symptomatic hyponatremia or increased intracranial pressure. Its use in burn resuscitation is not standard and carries a high risk of causing hypernatremia and osmotic demyelination.
• Option D: This is a colloid solution. In the first 24 hours after a major burn, capillary permeability is significantly increased. Administering colloids like albumin can cause them to leak into the interstitial space, worsening edema.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Fluid Resuscitation for Major Burns in acute care settings.
• Accurate fluid resuscitation is a cornerstone of early burn management to prevent burn shock, a life-threatening complication.
• Nurses must meticulously monitor urine output (target: 0.5-1 mL/kg/hr for adults) as it is the most crucial indicator of adequate tissue perfusion and successful resuscitation.
• What if? If the patient's urine output drops below 0.5 mL/kg/hr despite the calculated infusion rate, the nurse should anticipate an order to increase the fluid rate and must notify the provider immediately, as this indicates inadequate resuscitation and risk of acute kidney injury.

How to Approach the Question

• First, identify the key elements in the question: a major burn (40% TBSA) and the use of the Parkland formula.
• The question asks for the specific type of fluid used in this context.
• Recall the principles of fluid resuscitation in burns. The primary goal is to replace lost intravascular fluid with a solution that is physiologically similar to plasma.
• Evaluate the options. Ringer lactate is an isotonic crystalloid that closely mimics the body's extracellular fluid.
• Contrast this with the other options: 5% Dextrose becomes hypotonic, 3% saline is hypertonic, and Albumin is a colloid generally avoided in the initial phase. This makes Ringer lactate the only appropriate choice.

Concept Tested & Keywords

• Concept Tested: Fluid Resuscitation for Major Burns
• Stem keywords: 40% total body surface area burn, fluid resuscitation, Parkland formula
• Lead-in keywords: Which fluid
• Clinical cues: 40% TBSA burn: Indicates a severe burn requiring immediate and large-volume fluid replacement to prevent hypovolemic shock.
• Negative lead-in flag: false

Question ID

QbH64cx-5RXOA25h-FsRX2

Copy ID

Reference Book

E6 Nursing Fundamentals Taylor p. 835-837

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 142-144