Page 25 - 2026 SMOG

BURN FLUID RESUSCITATION
Rules of 9’s Burn % Estimation Chart

Adult >40kg
• Burns: 10mL/hr × % TBSA; for patients weighing more than 80kg, add 100mL/hr to IV fluid rate
for each 10kg over 80kg. Re-evaluate every 1–2 hours. Adjust IV rate to UOP goal of 30–50mL/hr.
˚ Adjust IV rate up or down by 20% based on UOP.
• High Voltage Injury: 10mL/hr × % TBSA (estimate to nearest 10%); for patients weighing more
than 80kg, add 100mL/hr to IV fluid rate for each 10kg over 80kg. Re-evaluate every 1–2 hours.
Adjust IV rate to UOP goal of 75–100mL/hr.
■ Adjust IV rate up or down by 20% based on UOP.
Pediatric <40kg
• Burns: 3 × %TBSA × body weight (kg) gives the volume for the initial 24hr. Give one-half in the
first 8 hours. Monitor urine output and adjust IV rate to UOP goal of 0.5–1mL/kg/hr.
• High Voltage Injury: Adjust IV rate to UOP goal 12mL/kg. Adjust IV rate up or down by 20%
based on UOP.
• Administer a maintenance rate of D5LR to children <20kg. Utilize the 4-2-1 rule: 4mL/kg for the
first 10kg + 2mL/kg for the 2nd 10kg + 1mL/kg over 20kg. This maintenance rate is in addition to
the isotonic infusion calculated for burn resuscitation and is not titrated.
Notes, Cautions, Warnings
• TBSA >20% may require acute fluid resuscitation in prehospital: LR (best) >NS (2nd best)
• Over Resuscitation: Avoid a runaway resuscitation by using a fluid adjunct during the
resuscitation.
˚ When to consider: projected fluid requirements >250mL/kg within the first 24 hours, crystalloid
infusion rate exceeds 1.5L/hr, vasopressor use despite ongoing fluid administration.
˚ Treatment: Fresh Frozen Plasma transfused at 0.5–1 unit per hour, depending on severity and
resources available.
• It is worth your time and effort to accurately estimate burn surface area, body weight, and then
calculate and administer appropriate fluids while the patient is under your care.
• Oral Resuscitation: In hemodynamically stable patients, WHO oral rehydration solution packets
(or commercially available rehydration salts) can be mixed with water to give fluids by mouth or
NGT if IVF is not available or in limited supply.
Reference: CPG ID #12 (Burn Care)

2026 Standard Medical Operating Guidelines (SMOG) • 17