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

Listen in Hindi

• The Parkland formula is used to calculate the total fluid requirement for a burn patient over 24 hours.
• The formula is: 4 mL of Lactated Ringer's × body weight in kg × %TBSA.
• Total 24-hour fluid: 4 mL × 80 kg × 40 = 12,800 mL.
• According to the formula's guidelines, half of this total volume is administered in the first 8 hours post-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 value represents the total fluid volume to be administered over a 24-hour period, not just the first 8 hours.
• Option C: This volume is one-fourth of the total 24-hour requirement. It represents half of the fluid that should be given in the first 8-hour block.
• Option D: This is a significant underestimation of the required fluid and does not correspond to any correct step in the Parkland formula calculation for this patient.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Fluid resuscitation using the Parkland (Baxter) formula for burn patients to guide bedside assessment, documentation, and the next nursing action.
• Prompt and accurate fluid resuscitation is the highest priority in early burn management to prevent burn shock, a form of hypovolemic shock caused by massive fluid shifts.
• Nurses must meticulously monitor urine output as a key indicator of adequate organ perfusion. The target for an adult is typically 0.5 mL/kg/hr (or 30-50 mL/hr).
• What if? If the patient arrived at the hospital 3 hours after the burn occurred, the nurse must administer the entire first 8-hour volume (6,400 mL) over the remaining 5 hours. This requires calculating a much higher hourly infusion rate (1,280 mL/hr) to catch up.

How to Approach the Question

• This is an analytical/calculation question requiring knowledge of a specific formula.
• First, identify all the variables provided in the question: weight (80 kg), %TBSA (40%), and the specific formula (Parkland).
• Recall the two parts of the Parkland formula: the calculation for the total 24-hour volume and the rule for administration (half in the first 8 hours).
• Step 1: Calculate the total 24-hour volume: 4 × 80 × 40 = 12,800 mL.
• Step 2: Calculate the volume for the specified time frame (first 8 hours) by dividing the total volume by 2: 12,800 / 2 = 6,400 mL.
• Compare your final answer with the options provided to select the correct one.

Concept Tested & Keywords

• Concept Tested: Fluid resuscitation using the Parkland (Baxter) formula for burn patients.
• Stem keywords: 80 kg, adult patient, full-thickness burns, 40% TBSA, Parkland (Baxter) formula, first 8 hours
• Lead-in keywords: what is the total volume
• Clinical cues: The question asks for the volume in the 'first 8 hours', which is a key component of the Parkland formula's administration schedule.

Question ID

QZSVXDTp5kDrNcghBYovad

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 pp. 694-696, 695-697

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 748-750