You are admitting a 20-month-old female 3 hours post partial-thickness scald burns. The burns are on the anterior torso and neck, the right upper extremity, and the right face. There are large blisters on the torso and upper extremities. In addition, splash marks on the left lower and upper extremities without blisters and intact skin. Using the rule of nines, you estimate the patient has 20% of the body surface burned. A 22G peripheral intravenous line is in the left arm, and 0.9% normal saline is infusing at 70 ml per hour. The transport team placed wet saline dressings before transport. The patient weighs 13.5 kg. Calculate the rate at which the patient's burn fluid resuscitation should be infused in the first 8 hours.

Choice A reason: A 99.5 ml/hour rate overestimates fluid needs for a 13.5 kg child with 20% burns. The Parkland formula (4 ml/kg/% burn) yields 1080 ml over 8 hours (540 ml first 8 hours ÷ 8 = 67.5 ml/hour), making this rate too high, risking fluid overload. Choice B reason: A 35.5 ml/hour rate underestimates fluid resuscitation for a 13.5 kg child with 20% burns. The Parkland formula calculates 540 ml for the first 8 hours (4 × 13.5 × 20 ÷ 2), or 67.5 ml/hour, insufficient fluid risks hypovolemia and shock. Choice C reason: A 33.8 ml/hour rate is too low for burn resuscitation in a 13.5 kg child with 20% burns. The Parkland formula gives 67.5 ml/hour (4 × 13.5 × 20 ÷ 2 ÷ 8), and under-resuscitation risks inadequate tissue perfusion, leading to organ failure. Choice D reason: For a 13.5 kg child with 20% burns, the Parkland formula (4 ml/kg/% burn) calculates 1080 ml total (4 × 13.5 × 20), with half (540 ml) in the first 8 hours, or 67.5 ml/hour. This rate ensures adequate hydration, preventing shock while avoiding fluid overload.