Which one is the real Parkland formula to estimate the fluid requirement in the first 24 hours in a serious burn patient?

Appeared in: UPPSC-2021

Explanation

The Parkland formula is a standard guideline for calculating the amount of intravenous fluid required for a burn patient in the first 24 hours.
The formula specifically uses a multiplier of 4 mL: Total Fluid = 4 mL × Body Weight (kg) × % Total Body Surface Area (TBSA) burned.
Lactated Ringer's is the recommended isotonic crystalloid solution for this resuscitation.
The administration is time-critical: half of the total volume is given in the first 8 hours from the time of injury, and the remaining half is given over the subsequent 16 hours.

Option B: A multiplier of 3 mL is not used in the standard Parkland formula. While some protocols for specific situations might adjust rates, 3 mL is not the basis of this widely accepted formula.
Option C: A multiplier of 2 mL is characteristic of the Modified Brooke formula, which is a different resuscitation protocol from the Parkland formula.
Option D: A multiplier of 1 mL is incorrect and would lead to severe under-resuscitation, increasing the risk of hypovolemic shock and organ failure in a patient with significant burns.

Clinical Relevance

Nursing practice connection: Use the key finding related to Parkland formula for burn fluid resuscitation to guide bedside assessment, documentation, and the next nursing action.
Accurate fluid resuscitation is critical to prevent burn shock, a life-threatening complication caused by massive fluid shifts from the intravascular to the interstitial space.
A crucial nursing responsibility is to remember that the 8-hour clock starts from the time of the burn injury, not from the time of hospital arrival. Any delay in starting resuscitation must be accounted for by increasing the initial infusion rate.
Nurses must meticulously monitor hourly urine output (target: 0.5-1 mL/kg/hr for adults) and titrate the infusion rate up or down to maintain adequate organ perfusion without causing fluid overload (fluid creep).

How to Approach the Question

Identify the key term in the question stem, which is 'Parkland formula'.
Recognize this as a factual recall question that requires knowledge of a specific medical formula.
Access your memory for the components of the Parkland formula, specifically the multiplier used.
Recall that the Parkland formula uses a multiplier of 4 mL.
Evaluate the given options and select the one that matches the correct formula: 4 mL × %TBSA × body weight in kg.

Concept Tested & Keywords

Concept Tested: Parkland formula for burn fluid resuscitation
Stem keywords: Parkland formula, fluid requirement, burn patient, first 24 hours
Lead-in keywords: Which one
Negative lead-in flag: false

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 694-696

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

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