Severe burns require careful fluid management. Because burns destroy the layers of skin that keep fluid inside the blood vessels, burn victims lose large amounts of fluid out of the leaking blood vessels. You must carefully calculate a burned toddler's fluid needs, because too much fluid or too little can kill them. Any toddler with a burn that covers over 10 percent of their body surface area needs fluid resuscitation, Catherine Williams, R.N. explains in the April 2008 issue of "Nursing Times." Hospitals use different formulas to calculate fluid requirements.
Step 1
Weigh the child. Fluid resuscitation is determined by the toddler's weight. Most formulas list the weight in kilograms, or kg rather than in lbs. To convert kg to lbs., multiply by 2.2.
Step 2
Assess the burned areas to determine the percentage of total body surface burned. Many centers use the "rule of nines" formula to figure out the percentage of burned area. This formula counts the head as 18 percent of the body and each arm as 9 percent of the body. Each leg counts as 14 percent; the back and the chest each count as 18 percent on a toddler. The perineum counts as 1 percent. Children's percentages differ from adults because they have shorter legs and heads that make up a larger proportion of their total body area than adults.
Step 3
Calculate the fluid volume needed for replacement over a 24-hour period. Plus the child's weight and percentage of body surface burned into the accepted formula used at the hospital where the child is being treated. The Parkland formula, a commonly used formula, uses this calculation: multiply the total body surface area burned times the weight in kg x 4 milliliters. Intravenous fluid is measured in milliliters, or ml. One ml and 1 cc, or cubic centimeter, equal the same amount. Lactated ringers fluid, abbreviated LR, is used for resuscitation, according to the University of Michigan.
Step 4
Figure the hourly maintenance rate. Children need more resuscitation fluid than adults. The Parkland formula gives a child under age 4 a fluid maintenance dose of 4 ml/kg for the first 10 kg of body weight plus 2 ml/kg for the second 10 kg of body weight, plus 1 ml/kg for over 20 kg of body weight. Maintenance fluid should be 5 percent dextrose and lactated ringers, or D5LR, according to the University of Michigan.
Step 5
Administer half the resuscitation fluid intravenously over the first eight hours and the rest over the next 16 hours. Divide the 24-hour total in half, then divide that number by eight to determine the hourly rate for the first six hours. To determine the resuscitation rate for the next 16 hours, divide half the fluid total by 16. The maintenance fluid rate remains the same every hour during the 24-hour period.
Tips and Warnings
- To make calculations simpler, use an online calculator that allows you to input your data and then figures the rate for you. In a toddler, urine output of 1.0 to 1.5 ml/kg/hour indicate good tissue perfusion, according to Williams. Use the child's palm surface as an approximation of 1 percent for scattered burns.
- Fluid resuscitation should be calculated from the time of the burn, not the time when fluid resuscitation started. If the burn occurred several hours before you started giving fluids, you need to "catch up" the fluid volume in the first few hours to keep the child hydrated. Your burn unit's protocols may vary. Always follow the standard on your unit.
Things You'll Need
- Scale
- Calculator
References
- University of Michigan Trauma Burn Center: Fluid Resuscitation
- Radiation Emergency Medical Management; Burn Triage and Treatment; Thermal Injuries; August 2006
- mdcalc: Parkland Formula for Burns
- "Nursing Times"; Fluid Resuscitation in Burns Patients; Catherine Williams, R.N.; April 2008
- University of Utah Health Sciences Center: Emergency Care of the Burn Patient
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