Instructions
The Parkland Formula estimates the total IV fluid volume for the first 24 hours post-burn (from time of injury, not arrival):
Total 24-h LR = 4 mL × weight (kg) × %TBSA (2nd/3rd degree burns only)
Administration schedule:
- First 8 hours from time of burn: give ½ of total volume
- Next 16 hours: give remaining ½
Only 2nd- and 3rd-degree burns count toward TBSA. Superficial (1st-degree) burns are excluded.
For children: the Modified Parkland (Galveston formula) is preferred — it includes maintenance fluids and adjusts for body surface area. Do not use adult Parkland in pediatric patients without modification.
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When to Use
Appropriate population
Adults with major burns requiring IV fluid resuscitation: ≥20% TBSA in adults, ≥15% TBSA in children or elderly. Also use in any burn patient with suspected burn-associated AKI where urine output monitoring is essential. Indicated when burns are deep partial-thickness (2nd degree) or full-thickness (3rd degree).
Important limitations
This formula does not apply to electrical burns or burns with significant inhalation injury — their resuscitation volumes and strategies differ. The Parkland Formula is an initial starting point; actual fluid administration must be titrated to hourly urine output and hemodynamic response. It is not validated for pediatric use without modification.
Pearls & Pitfalls
Key pearls
- This is an estimate — titrate to urine output (0.5–1 mL/kg/h adults, 1 mL/kg/h children)
- Use Lactated Ringer's, not normal saline, to avoid hyperchloremic acidosis
- The Modified Brooke formula (2 mL × kg × %TBSA) is an alternative with lower starting volumes
- CKD/pre-existing renal disease: adjust carefully; seek early nephrology input
- The patient's palm (including fingers) ≈ 1% TBSA — useful for scattered burns
Pitfalls — fluid creep
Over-resuscitation ("fluid creep") causes abdominal compartment syndrome — avoid. Do not count electrical burns or inhalation injury — their volumes may differ significantly. Do not start the clock at time of arrival; start from time of burn. Reassess at 8 hours; consider albumin supplementation after 12–18 hours in large burns (>30–40% TBSA).
Why Use It
Burns are a common cause of hospital-acquired AKI. Inadequate resuscitation causes renal ischemia and acute tubular necrosis; fluid excess causes abdominal compartment syndrome compressing renal venous outflow. The Parkland Formula provides a validated, widely accepted starting estimate that has been the standard of burn resuscitation since Baxter's landmark 1974 work. Early, goal-directed resuscitation — guided by Parkland and titrated to urine output — remains the cornerstone of preventing burn-associated multiorgan failure including AKI.
Parkland Formula — Burns Fluid Resuscitation
Enter weight, %TBSA (2nd/3rd degree burns only), and hours since burn. Total 24-hour volume and hourly rates update automatically.
Rule of Nines — Adult TBSA Quick Reference
| Body Region | %TBSA (Adult) |
|---|---|
| Head + neck | 9% |
| Each arm (entire) | 9% × 2 = 18% total |
| Anterior trunk (chest + abdomen) | 18% |
| Posterior trunk (upper + lower back) | 18% |
| Each leg (thigh 9% + lower leg 9%) | 18% × 2 = 36% total |
| Perineum / genitalia | 1% |
| Total | 100% |
Patient's palm (including fingers) ≈ 1% TBSA. In children, the head is larger (18%) and legs are smaller — use the Lund-Browder chart instead.
Next Steps
Use the Parkland volume as the starting point — titrate to clinical response throughout resuscitation.
- Monitor urine output hourly via Foley catheter — target 0.5–1 mL/kg/h in adults, 1 mL/kg/h in children
- Adjust IV rate up or down by 25–33% based on urine output response
- Reassess fluid balance at 8 hours (end of first-half infusion)
- Consider colloid (albumin 5%) supplementation after 12–18 hours in large burns (>30–40% TBSA) — may reduce total crystalloid load
- Consult burn surgery / burn unit for burns >10% TBSA, or any special-area burn (face, hands, feet, genitalia, major joints, circumferential)
- Monitor for abdominal compartment syndrome (bladder pressure) if resuscitation volume escalates significantly
- In patients with CKD: early nephrology input; monitor creatinine and electrolytes closely; avoid hyperchloremia
Evidence & References
Primary Reference
Baxter CR. Fluid volume and electrolyte changes of the early postburn period. Clin Plast Surg. 1974;1(4):693–703.
Practice Guidelines
ISBI Practice Guidelines Committee. ISBI Practice Guidelines for Burn Care. Burns. 2016;42(5):953–1021.
Alternative Formula
Modified Brooke Formula: 2 mL × kg × %TBSA (Lactated Ringer's). Produces lower volumes and is equally evidence-supported. Many burn centers use 2–4 mL/kg/%TBSA as a range, titrated to urine output.
