CBM Fluid Resuscitation & Management 3 — Questions and Answers
Question 1: For pediatric burn patients, the Galveston formula adds maintenance fluids to the resuscitation calculation. What is the maintenance component?
- 1,500 mL/m² body surface area/day
- 2,000 mL/m² body surface area/day (Correct answer)
- 1,000 mL/m² body surface area/day
- 500 mL/m² body surface area/day
Correct answer: 2,000 mL/m² body surface area/day
The Galveston formula adds 2,000 mL/m² total BSA for maintenance to account for the higher surface-area-to-volume ratio and metabolic needs in children.
Question 2: Hypertonic saline resuscitation in burn patients is theorized to reduce total fluid volume by:
- Increasing renal filtration rate
- Drawing interstitial fluid into the intravascular space via osmotic gradient (Correct answer)
- Stimulating aldosterone release to retain sodium
- Reducing capillary permeability directly
Correct answer: Drawing interstitial fluid into the intravascular space via osmotic gradient
Hypertonic saline creates an osmotic gradient that draws fluid from the interstitium into the vasculature, theoretically reducing total resuscitation volumes.
Question 3: During the emergent phase of a major burn, capillary leak is most pronounced within the first:
- 6–8 hours
- 18–24 hours (Correct answer)
- 48–72 hours
- 72–96 hours
Correct answer: 18–24 hours
Capillary permeability peaks within the first 18–24 hours post-burn before gradually normalizing, which is why aggressive crystalloid resuscitation is prioritized early.
Question 4: What is the primary reason lactated Ringer's solution is preferred over normal saline for burn resuscitation?
- It contains more sodium per liter
- It avoids hyperchloremic metabolic acidosis associated with large volumes of normal saline (Correct answer)
- It provides glucose for energy needs
- It has a higher osmolarity matching plasma
Correct answer: It avoids hyperchloremic metabolic acidosis associated with large volumes of normal saline
Large volumes of normal saline cause hyperchloremic metabolic acidosis; lactated Ringer's is more physiologically balanced and avoids this complication.
Question 5: Which hemodynamic parameter, when used with goal-directed therapy, helps avoid both under- and over-resuscitation in burn patients?
- Mean arterial pressure alone
- Stroke volume variation (SVV) monitored continuously (Correct answer)
- Central venous pressure (CVP)
- Heart rate only
Correct answer: Stroke volume variation (SVV) monitored continuously
Stroke volume variation (SVV) via invasive monitoring provides dynamic preload responsiveness data, enabling more precise fluid titration than static parameters like CVP.
Question 6: In a patient with a 60% TBSA burn weighing 80 kg, the Parkland formula 24-hour fluid total is:
- 9,600 mL
- 12,800 mL
- 19,200 mL (Correct answer)
- 24,000 mL
Correct answer: 19,200 mL
Parkland formula: 4 mL × 80 kg × 60% TBSA = 19,200 mL total over 24 hours, with 9,600 mL given in the first 8 hours.
Question 7: Which electrolyte abnormality is most commonly seen during aggressive crystalloid burn resuscitation?
- Hyperkalemia
- Hyponatremia (Correct answer)
- Hypermagnesemia
- Hypercalcemia
Correct answer: Hyponatremia
Large volumes of hypotonic or isotonic crystalloid dilute serum sodium, causing hyponatremia, particularly in pediatric patients.
CBM Fluid Resuscitation & Management 3
For pediatric burn patients, the Galveston formula adds maintenance fluids to the resuscitation calculation.
What is the maintenance component?