A practical formula for fluid resuscitation in acute paediatric burns in a low resource setting: A pilot study

  • NL Allorto
    Corresponding author.
    Greys Hospital, Department of Surgery, Pietermaritzburg Metropolitan, KwaZulu Natal, South Africa

    University of KwaZulu Natal, KwaZulu Natal, South Africa
    Search for articles by this author
  • SL Wall
    Edendale Hospital, Department of Surgery, Pietermaritzburg Metropolitan, KwaZulu Natal, South Africa

    University of KwaZulu Natal, KwaZulu Natal, South Africa
    Search for articles by this author


      • Fluid resuscitation is challenging in low resource settings.
      • Pilot study to evaluate safety of a new protocol.
      • Practical protocol appears safe and reasonable.



      Appropriate fluid resuscitation of acute burn injury is critical and there are recognized challenges with fluid resuscitation, including those with relevance to low resource settings. We developed a practical protocol that guides burn resuscitation and sought to evaluate the safety of our modified resuscitation formula through a small pilot study that particularly addresses the problems we have experienced in a low resource setting.


      Children with burns more than 15% total body surface area admitted within 24 h of injury to Edendale Hospital between 1 June 2021 and 31 August 2021 were included. The resuscitation formula used was 2 mls of Ringers Lactate per bodyweight in kilograms per% total body surface area (TBSA) given over 24 h and adjusted according to urine output. Data analysed included age, weight, mechanism, TBSA, hours post burn at presentation to hospital, total fluid given in the first 24 h of admission, total urine output in the first 24 h of admission, number of fluid adjustments made during the first 24 h and complications related to fluid resuscitation.


      Ten children were included. The median age was 3 (IQR 2–5) years old, with a mean weight of 14.9 (SD 5.07) kilograms, a median TBSA of 17.4 (IQR 16–26)%, presenting at a median of 12 (6.5–18) hours post burn injury. Mechanism of burn was scald in all cases, with 9 being hot water and hot food in one. In the first 24 h a mean of 2.05 (SD 0.58) mls/kg of fluid was received with a mean urine output of 1.66 (SD 0.57) mls/kg/hr.


      The results of this pilot study to evaluate the safety of our protocol seem reasonable. It is limited by the lack of larger injuries as well as adult patients and a larger prospective study is pertinent.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • ISBI Practice Guidelines Committee; Steering Subcommittee; Advisory Subcommittee
        ISBI Practice Guidelines for Burn Care.
        Burns. 2016; 42 (Doi: 10.1016/j.burns.2016.05.013. PMID: 27542292): 953-1021
        • Pham T.N.
        • Cancio L.C.
        • Gibran N.S.
        American Burn Association. American Burn Association practice guidelines burn shock resuscitation.
        J Burn Care Res. 2008; 29 (Doi:PMID: 18182930): 257-266
        • Tricklebank S.
        Modern trends in fluid therapy for burns.
        Burns. 2009; 35 (Doi:Epub 2009 May 30. PMID: 19482429): 757-767
        • Perry V.
        • Teague W.J.
        Same formula, different philosophy: more mindful use of the Modified Parkland Formula in severe burns.
        ANZ J Surg. 2021; 91 (Doi:PMID: 33847054): 490-492
        • Mehta M.
        • Tudor G.J.
        Parkland Formula.
        ([Updated 2021 Nov 16]. In:)StatPearls [Internet]. treasure island (FL). StatPearls Publishing, 2022 (Jan-. Available
        • Ete G.
        • Chaturvedi G.
        • Barreto E.
        • Paul M.K
        Effectiveness of Parkland formula in the estimation of resuscitation fluid volume in adult thermal burns.
        Chin J Traumatol. 2019; 22 (Doi:Epub 2019 Mar 2. PMID: 30962126; PMCID: PMC6488519): 113-116
        • Leclerc T.
        • Potokar T.
        • Hughes A.
        • Norton I.
        • Alexandru C.
        • Haik J.
        A simplified fluid resuscitation formula for burns in mass casualty scenarios: analysis of the consensus recommendation from the WHO Emergency Medical Teams Technical Working Group on Burns.
        Burns. 2021; 47 (Doi:Epub 2021 Feb 27. PMID: 33707086): 1730-1738
        • Ho G.
        • Camacho F.
        • Rogers A.
        • Cartotto R.
        Early Acute Kidney Injury Following Major Burns.
        J Burn Care Res. 2021; 42 (Doi:Erratum in: J Burn Care Res. 2021 Mar 4;42(2):350. PMID: 32745167): 126-134
        • Palmieri T.
        • Lavrentieva A.
        • Greenhalgh D.
        An assessment of acute kidney injury with modified RIFLE criteria in pediatric patients with severe burns.
        Intensive Care Med. 2009; 35 (Doi:Epub 2009 Sep 15. PMID: 19756500; PMCID: PMC2779390): 2125-2129
        • Snell J.A.
        • Loh N.H.
        • Mahambrey T.
        • Shokrollahi K.
        Clinical review: the critical care management of the burn patient.
        Crit Care. 2013; 17 (Published 2013 Oct 7Doi:): 241
        • Guilabert P.
        • Usúa G.
        • Martín N.
        • Abarca L.
        • Barret J.P.
        • Colomina M.J.
        Fluid resuscitation management in patients with burns: update.
        Br J Anaesth. 2016; 117 (Doi:): 284-296