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Burns Resuscitation Titration — FRCA Final MCQ

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ModerateTrauma & Emergency AnaesthesiaBurns Resuscitation TitrationFRCA Final

A 35-year-old man (ASA I, 75 kg) sustains a significant burn (35% TBSA, mixed depth) 6 hours ago. He has been fluid-resuscitated per the Parkland formula. His urine output is 0.3 mL/kg/hr (target 0.5-1 mL/kg/hr). His HR is 110, BP 100/65. What adjustment should be made?

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Correct answer: E — Increase the IV fluid rate by 30% for the next hour and reassess

In burn resuscitation, the Parkland formula provides a starting estimate. Fluid rates must be titrated to clinical endpoints, primarily urine output (0.5-1 mL/kg/hr in adults, 1-2 mL/kg/hr in children). This patient's urine output of 0.3 mL/kg/hr is inadequate, suggesting under-resuscitation. The fluid rate should be increased by 20-30% for the next hour and urine output reassessed. Other endpoints include: HR <120, MAP >60, lactate trending down, and base deficit improving. Excessive fluid administration (>6 mL/kg/%TBSA in 24 hours) should trigger consideration of colloid addition (albumin) rather than further crystalloid.

Reference: NICE – 2020 – NG156 Burns; British Burns Association – 2018 – Burn care standards