Parkland formula for burns
First 24-hour fluid for burns from weight and % TBSA.
What this calculator is for
Major burns cause rapid fluid loss from damaged capillaries. The Parkland formula estimates the crystalloid needed in the first 24 hours. In the UK, formal resuscitation is usually started for burns of 15% TBSA or more in adults and 10% or more in children.
The formula
Total fluid in 24 hours = 4 mL × weight (kg) × % total body surface area (TBSA) burned, using Ringer's lactate (Hartmann's). Give half in the first 8 hours from the time of the burn, not from arrival, and the other half over the next 16 hours.
ATLS (10th edition) starts adults with thermal burns at 2 mL/kg/%TBSA and children at 3 mL/kg/%TBSA, keeping 4 mL for electrical injury. Follow your burns unit's protocol; whichever you start with, the urine output decides the rate.
Estimating TBSA
- Count only partial- and full-thickness burns. Do not count simple redness.
- Rule of nines in adults: head 9%, each arm 9%, front of trunk 18%, back of trunk 18%, each leg 18%, perineum 1%.
- The patient's palm with fingers closed is about 1% of their body surface. Useful for patchy burns.
- Children have larger heads and smaller legs; use a Lund and Browder chart.
Worked example
A 60 kg adult with 30% TBSA burns arrives 2 hours after injury. Total = 4 × 60 × 30 = 7200 mL. The first 3600 mL is due by 8 hours after the burn, so give it over the remaining 6 hours (600 mL/hour), then 3600 mL over 16 hours (225 mL/hour).
Monitoring and pitfalls
- Catheterise and titrate to urine output: 0.5 mL/kg/hour in adults and 1 mL/kg/hour in children. Increase or reduce the rate by about a third if the output is off target.
- Over-resuscitation is common and causes compartment syndrome, pulmonary oedema and worse oedema of the burn.
- Children also need maintenance fluid with dextrose on top of the Parkland volume.
- Suspect inhalation injury with burns in an enclosed space, facial burns, soot in the mouth or a hoarse voice, and get an anaesthetist early.
- Look for associated trauma and give tetanus cover.
See burns and scalds, the shocked patient, urinary catheterisation, Ringer's lactate and tetanus toxoid.
Frequently asked questions
What is the Parkland formula?
4 mL × body weight (kg) × % TBSA burned, given as Ringer's lactate over 24 hours: half in the first 8 hours from the time of the burn and half over the next 16 hours.
Does first-degree (superficial) burn count in the Parkland formula?
No. Simple redness without blisters is not counted. Only partial-thickness and full-thickness burns are included in the TBSA.
When does the 8-hour period start?
From the time of the burn, not from arrival at hospital. If the patient arrives late, the first half is given over the remaining hours.
How do I know the fluid rate is right?
Urine output: aim for 0.5 mL/kg/hour in adults and 1 mL/kg/hour in children, and adjust the rate if it is above or below target.
A calculator supports, but does not replace, clinical judgement. Check results before acting on them.