Parkland Burn Formula Calculator

The Parkland formula

Total 24-hour fluid (mL) = 4 × weight (kg) × %TBSA. Half of the total volume is given in the first 8 hours from the time of the burn (not from arrival to the ED); the second half is given over the next 16 hours. The fluid of choice is Lactated Ringer's. Time zero is the time of injury, so if the patient arrives 2 hours after the burn, the first-8-hour volume must be delivered in the remaining 6 hours.

Worked example

70 kg adult with 30% TBSA burn. Calculation: 4 × 70 × 30 = 8,400 mL total over 24 hours. First 8 hours: 4,200 mL = 525 mL/hr. Second 16 hours: 4,200 mL = 263 mL/hr. Use Lactated Ringer's. If the patient arrived 2 hours after injury, the 4,200 mL first-half must be infused over the remaining 6 hours = 700 mL/hr.

What counts as %TBSA

Use the Rule of Nines (adult): each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, head 9%, perineum 1%. Only second-degree (partial-thickness) and third-degree (full-thickness) burns are counted toward TBSA — superficial (first-degree, sunburn-type) burns are NOT included. The Lund-Browder chart gives more accurate TBSA for pediatric patients (head is proportionally larger).

Endpoints — how to know it's working

The Parkland formula is a starting estimate, not a fixed prescription. Titrate to urine output: 0.5 mL/kg/hr in adults, 1 mL/kg/hr in pediatric patients. If urine output is below target, increase the rate by 25% and reassess in 1 hour. Mean arterial pressure ≥65 mmHg is also a target. Most patients require ±25% of the calculated volume.

When NOT to use Parkland alone

Pediatric patients <30 kg: use Galveston formula or Parkland with maintenance fluids added (5,000 mL/m² BSA/24h for the burn + 2,000 mL/m² BSA/24h maintenance). Inhalation injury, electrical burns, and delayed presentation may all require higher-volume protocols. Always involve a burn center for >10% TBSA in adults or >5% in children.

How to actually run a Parkland resuscitation at the bedside

The number on a calculator is the start, not the prescription. Real burn resuscitation is a continuous nurse-driven titration against urine output, measured every hour through a Foley catheter. The American Burn Association target is 0.5 mL/kg/hr for adults, 1 mL/kg/hr for children under 30 kg, and 1 mL/kg/hr for adults with high-voltage electrical burns or rhabdomyolysis. If urine output falls below target, increase the LR rate by 25% and reassess in 60 minutes. If urine output is consistently above target (a common error called "fluid creep"), reduce the rate by 25%. Over-resuscitation is now recognized as a major cause of compartment syndromes, ARDS, and ICU mortality — the goal is the lowest fluid that maintains adequate perfusion, not a fixed delivery of the calculated total.

Documentation should include: time of burn, time IV resuscitation started, total Parkland volume calculated, %TBSA estimate (and who estimated it), first-8-hour goal rate, second-16-hour goal rate, hourly urine output, and every rate change with rationale. The handoff to the burn center includes all of this plus the running total of LR delivered to the moment of transfer. Most regional burn centers prefer to take over fluid management on arrival, but they need accurate intake numbers to do so.

Inhalation injury and the modified Parkland

Patients with concurrent inhalation injury require additional fluid beyond the Parkland calculation — typically an extra 1.5–2 mL/kg/%TBSA on top of the 4 mL/kg/%TBSA baseline. Inhalation injury is suspected with: facial burns, singed nasal hairs, carbonaceous sputum, hoarseness, stridor, or any history of being trapped in an enclosed-space fire. Carboxyhemoglobin level should be drawn early, and any level >10% in a non-smoker confirms significant smoke inhalation. Treatment is 100% non-rebreather oxygen and consideration of hyperbaric therapy in severe cases. Inhalation injury is the single largest predictor of in-hospital mortality after burn size and patient age — flag it loudly in handoff.

Pitfalls in TBSA estimation that change everything

The Rule of Nines is fast but consistently overestimates burns less than 10% and underestimates burns over 50%. The Lund-Browder chart, originally published in 1944 and now part of every burn-center protocol, accounts for the larger relative head-to-body ratio in children and adjusts torso/limb proportions by age. The patient's palm (including fingers) approximates 1% TBSA — useful for scattered burns. The most common nursing error is including superficial (first-degree, erythema-only) burns in the TBSA estimate; these do not count and including them inflates the Parkland total by 30–50%, leading directly to fluid creep. Only partial-thickness (red, blistered, blanching) and full-thickness (white, leathery, non-blanching, painless centrally) burns are counted. When in doubt, photograph the burn pattern and have the burn center attending re-estimate by tele-consult before starting massive resuscitation.