An 80 kg adult patient has sustained full-thickness burns covering 40% of their Total Body Surface Area (TBSA). Using the Parkland (Baxter) formula for fluid resuscitation (4 mL×kg×%TBSA), what is the total volume of Lactated Ringer's solution (in mL) the nurse should administer in the first 8 hours from the time of injury?

1. A

   12,800 mL

2. B

   6,400 mL

3. C

   3,200 mL

4. D

   1,600 mL

Appeared in: NORCET 9 Prelims-2025

Explanation

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• The Parkland (Baxter) formula is used to calculate the total fluid needed for a burn patient in the first 24 hours.
• The formula is: 4 mL × body weight in kg × percentage of Total Body Surface Area (TBSA) burned.
• For this patient: 4 mL × 80 kg × 40% = 12,800 mL total fluid in 24 hours.
• Crucially, half of this total volume is administered in the first 8 hours after the burn injury.
• Therefore, the volume for the first 8 hours is 12,800 mL / 2 = 6,400 mL.

Why Other Options Were Wrong

• Option A: This is the total fluid volume required over 24 hours, not the volume for the first 8 hours.
• Option C: This value represents one-quarter of the total 24-hour fluid requirement, which corresponds to the amount that would be given over a 4-hour period in the second phase of resuscitation (from hours 9 to 24).
• Option D: This value is one-eighth of the total 24-hour fluid requirement and does not align with any standard time frame in the Parkland formula.

Related Visual

• Visual 1: Flowchart - A flowchart illustrating the step-by-step calculation using the Parkland formula, from initial data (weight, TBSA) to the final 8-hour and 16-hour fluid volumes.
• Visual 2: Infographic - An infographic explaining the 'Rule of Nines' used to estimate the Total Body Surface Area (TBSA) affected by burns in adults, which is a prerequisite for using the Parkland formula.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Fluid resuscitation calculation using the Parkland (Baxter) formula for burn patients to guide bedside assessment, documentation, and the next nursing action.
• Accurate fluid resuscitation is critical in major burns to prevent burn shock, a life-threatening complication caused by massive fluid shifts from the bloodstream into the surrounding tissues.
• Nurses must meticulously monitor the patient's response to fluid therapy, primarily through urine output. The target for an adult is typically 0.5 mL/kg/hr. Fluid rates are adjusted based on this output.
• What if the patient was a child weighing 20 kg? The 'Rule of Nines' is less accurate in children. The Lund-Browder chart is preferred for TBSA estimation. The fluid calculation would be 4 mL x 20 kg x 40% = 3,200 mL total, with 1,600 mL in the first 8 hours, plus maintenance fluids.

How to Approach the Question

• First, identify the question type. This is an analytical, calculation-based question requiring application of a specific formula.
• Identify all the given variables from the question stem: Patient's weight (80 kg) and the percentage of TBSA burned (40%).
• Recall the Parkland (Baxter) formula: Total Fluid (24h) = 4 mL × Weight (kg) × %TBSA.
• Perform the first step of the calculation: 4 × 80 × 40 = 12,800 mL. Recognize this is the total for 24 hours.
• Recall the administration rule for the Parkland formula: Half of the total volume is given in the first 8 hours.
• Perform the second step: 12,800 mL / 2 = 6,400 mL.

Concept Tested & Keywords

• Concept Tested: Fluid resuscitation calculation using the Parkland (Baxter) formula for burn patients.
• Stem keywords: 80 kg, full-thickness burns, 40% TBSA, Parkland (Baxter) formula, first 8 hours
• Lead-in keywords: what is the total volume

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QZSVXDTp5kDrNcghBYovad

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