Clinical Medicine & Physiology
Modified Brooke Burn Fluid Resuscitation (2 mL/kg/%TBSA) & Curreri Calorie Formula
Calculate ATLS / ABA initial 24-hour Modified Brooke Lactated Ringer’s resuscitation volume (2 mL * kg * %TBSA, first-8h hourly infusion rate) to prevent "fluid creep," alongside P. William Curreri’s adult burn hypermetabolic nutrition formula (25 * kg + 40 * %TBSA).
Why ATLS 10th Edition shifted initial adult thermal burn resuscitation from 4 mL (Parkland) to 2 mL (Modified Brooke)!
Over-resuscitation ("fluid creep") with 4 mL/kg/%TBSA crystalloid was linked across burn centers to abdominal compartment syndrome, pulmonary edema, and extremity compartment syndromes! Consequently, the American College of Surgeons ATLS (10th Edition) and American Burn Association (ABA) consensus guidelines standardized initial adult flame/scald resuscitation (>= 20% partial- and full-thickness TBSA; 1st-degree erythema excluded!) on the Modified Brooke Formula: V_24h = 2 mL * Weight_kg * %TBSA of warmed Lactated Ringer’s, administering half in the first 8 hours FROM TIME OF BURN INJURY (8 - t_prehosp hours remaining) and titrating subsequent rates strictly to 0.5 mL/kg/hr urine output!
For early enteral nutrition across major burns (where catecholamine surge can double metabolic demand), P. William Curreri et al.’s (1974) classic ceiling estimator Curreri_kcal = 25 * Weight_kg + 40 * MIN(%TBSA, 50) caps %TBSA at 50% so massive >50% burns are protected against hyperglycemic/steatotic overfeeding while awaiting indirect calorimetry!
| Burn Protocol Calculation (80 kg Adult, 35% 2nd/3rd-Degree TBSA, 2 hr Pre-Hospital Delay) | Formula | Evaluated Target |
|---|---|---|
| Modified Brooke Total 24-Hour Crystalloid Volume | 2 * Weight_kg * %TBSA | 5,600 mL |
| Initial Hourly LR Rate Across Remaining 6 Hours of First 8h Window | (0.5 * V_24h) / (8 - t_delay) | 466.7 mL/hr |
| Second 16-Hour Baseline Hourly LR Rate (Titrate to UOP) | (0.5 * V_24h) / 16 | 175.0 mL/hr |
| Curreri Adult Burn Calorie Ceiling (Capped at 50% TBSA) | 25 * Weight_kg + 40 * MIN(%TBSA, 50) | 3,400 kcal/day |
Modified Brooke First-Window Hourly LR Infusion Rate (mL/hr, Adjusted for Pre-Hospital Elapsed Hours)
Divides first-half Modified Brooke volume (1 * Weight_kg * %TBSA) by remaining hours (8 - B4) from time of burn injury.
=IF(OR(B2 <= 0, B3 <= 0, B3 > 100, B4 < 0, B4 >= 8), "Invalid Weight, %TBSA (1–100), or Elapsed Delay >= 8h", ROUND((B2 * B3) / (8 - B4), 1))Curreri Adult Burn Hypermetabolic Energy Estimate (Capped at 50% TBSA, kcal/day)
Evaluates 25 * Weight_kg + 40 * MIN(%TBSA, 50) to prevent excessive overfeeding above 50% TBSA.
=IF(OR(B2 <= 0, B3 <= 0, B3 > 100), "Invalid Weight or %TBSA", ROUND(25 * B2 + 40 * MIN(B3, 50), 0))Try the example
Use the original values or change them to test your understanding.