## Clinical Context This patient has a scald burn (lower limbs anterior + posterior = 36%, lower abdomen = 9% → ~45% TBSA) with mixed partial-thickness injury (erythema with blistering, intact sensation = 1st and 2nd degree). She is 4 hours post-injury with tachycardia (HR 110), normal BP, and **inadequate urine output (0.3 mL/kg/hr)**, indicating early hypovolemic state and insufficient fluid resuscitation. ## Fluid Resuscitation Targets | Parameter | Target | |---|---| | Urine output (adults) | 0.5–1 mL/kg/hr | | Urine output (children) | 1 mL/kg/hr | | Heart rate | <120/min | | Systolic BP | >90 mmHg | | Serum lactate | Normalizing | | Urine osmolality | <300 mOsm/L | ## High-Yield: **The Parkland formula provides an initial estimate; ongoing titration based on urine output is the gold standard for fluid management.** Urine output is the most reliable real-time marker of adequate perfusion in burns. ## Key Point: **Current urine output of 0.3 mL/kg/hr is INADEQUATE.** The patient is in the resuscitation phase and requires increased IV fluids to reach the target of 0.5–1 mL/kg/hr. This is titration, not a new calculation. ## Clinical Pearl: In the first 24–48 hours post-burn, "fluid creep" (over-resuscitation) is a risk, but under-resuscitation is more immediately dangerous. Tachycardia + low urine output = inadequate perfusion → increase fluids now. ## Why This Is the Next Step 1. **Immediate problem:** Low urine output indicates inadequate renal perfusion and risk of ATN. 2. **Mechanism:** Increased IV infusion rate will increase intravascular volume and glomerular filtration pressure. 3. **Monitoring:** Reassess urine output in 1 hour; if still <0.5 mL/kg/hr, further increases or investigation for complications (inhalation injury, rhabdomyolysis) is warranted. 4. **No need to recalculate:** The Parkland formula is a starting point; titration is the standard of care. [cite:Park 26e Ch 12]
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