Burns - Fluids


These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

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To guide staff in the use of IV fluids in the child with significant burns.



The aims of intravenous fluids in a child with burns are:
  • To rehydrate the child with a major body surface area (BSA) burn (this excludes simple erythema):
    • 0-18 months: 8% and over
    • Older children: 10% and over
  • To achieve adequate perfusion of all potentially viable tissue and to maintain function of all vital organs, as evidenced by adequate and not excessive urine output.



The following baseline tests need to be obtained if an IV cannula is inserted:
  • FBC, LFT, U&E, BGL
  • Venous Blood Gas (VBG) (if inhalation burns or carbon monoxide poisoning is suspected)
  • Group and Hold (if other injuries are present secondary to trauma).



Initial management

Burns resuscitation fluids according to the Parkland Formula

To be added to the child’s normal maintenance fluids.

Calculate the volume required for fluid replacement using the following formula: % BSA x weight (in kg) x 2
  • To assess the % BSA use the Burns Body Surface Area Sheet (PDF 68kb).
  • This gives an estimate of the volume of replacement fluid required in the first 24 hours from the time of the burn (not from time of arrival in hospital).
Administer this calculated volume using Hartmann’s solution as follows:
  • 50% within the first 8 hours
  • 50% over the next 16 hours.
Adjustments may be required based on the ongoing assessment of the child.

The Burns Registrar will recalculate the estimated % BSA during the initial assessment.


Total fluid requirement calculation: 

Total fluid = rehydration fluid (Parkland) + maintenance fluid (given as an hourly rate)
  • Any volume of fluid given and tolerated orally or by nasogastric tube should be deducted from the IV fluid volume that is required to maintain the desired urine output.
  • Monitor urine output closely after first 2 hours.

Urine output

  • As a rule, if a burn is severe enough to require IV fluid resuscitation, then urine output should be properly monitored with a catheter.
  • Optimal urine output 0.5 – 1mL/kg/hr for paediatric burns fluid resuscitation patients.
  • Adjust fluid rate to compensate.
  • Consult Burns Fluid Calculator (external site).

Further management

Neurovascular observations

  • The burn must be elevated to reduce swelling (especially important in circumferential burns).
  • The neurovascular status must be observed closely.
  • Excessive fluids may result in increasing oedema, possibly compromising the circulation and necessitate an escarotomy.
  • Early review by the Burns Registrar or Consultant is vital if there are any concerns regarding vascular compromise.


Consult Burns - Analgesia and dosing.


  1. AMH Children’s Dosing Companion (2015) Australian Medicines Handbook Pty Ltd
  2. Textbook of Paediatric Emergency Medicine 2nd Edition Cameron Elesevier 2012
  3. Nelson Textbook of Pediatrics: 20th Edition Robert M. Kliegman, Bonita M.D. Stanton, Joseph St. Geme, Nina F Schor Publisher: Elsevier 

Document owner:  Emergency Department Director, PCH Burns team    
Reviewer/Team:  Emergency Department Guidelines team    
Endorsed by:  Director, Emergency Department  Date:   February 2018

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