Parkland Formula: Burn Fluid Resuscitation
Calculate 24-hour intravenous fluid requirements for burn patients using the Parkland formula (4 mL/kg/%TBSA).
The Parkland Formula: Burn Fluid Resuscitation
The Parkland Formula (also known as the Baxter formula) is the most widely recognized and utilized method globally in emergency and intensive care departments to calculate the intravenous fluid requirements of severely burned patients during the first 24 hours post-injury.
How does the calculation work?
The classic formula recommends 4 mL of Lactated Ringer's per kilogram of body weight, multiplied by the percentage of Total Body Surface Area (TBSA) burned. The administration is crucial:
- The first 8 hours: 50% of the total calculated volume must be administered within 8 hours from the time of the burn (not the time of hospital arrival).
- The next 16 hours: The remaining 50% is administered progressively over the subsequent 16 hours.
- Surface Area Assessment: Only 2nd and 3rd-degree burns are taken into account. Sunburns (1st degree) are excluded.
Monitoring and Adjustments
The Parkland formula is a starting point. Resuscitation must always be titrated according to the patient's physiological response. The primary clinical target is to maintain a urine output between 0.5 and 1.0 mL/kg/hour in adults.
Surface Estimation (Wallace Rule of Nines - Adult)
| Anatomical Region | Percentage (%) |
|---|---|
| Head and neck (entire) | 9 % |
| Each arm (entire) | 9 % (Total 18%) |
| Anterior trunk (Front) | 18 % |
| Posterior trunk (Back) | 18 % |
| Each leg (entire) | 18 % (Total 36%) |
| Perineum / Genitals | 1 % |
References:
1. Baxter CR. Fluid volume and electrolyte changes of the early postburn period. Clin Plast Surg. 1974;1(4):693-703.
[ScienceDirect]
2. ISBI Practice Guidelines Committee. ISBI Practice Guidelines for Burn Care. Burns. 2016;42(6):953-1021.
[ISBI Guidelines]
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