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: the American Burn Association’s 2008 practice guideline targets 0.5 to 1 mL/kg/hr in adults and 1 to 1.5 mL/kg/hr in children. How much to change the rate, and how often, comes from your burn center’s protocol. The volume a patient actually needs often differs from the calculated figure, which is why the rate is titrated rather than fixed.

When NOT to use Parkland alone

Pediatric patients <30 kg: use Galveston formula or Parkland with maintenance fluids added (Galveston: 5,000 mL per m² of burned surface area plus 2,000 mL per m² of total body surface area in the first 24 hours; confirm against your burn center’s pediatric protocol). 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’s 2008 guideline targets 0.5 to 1 mL/kg/hr in adults and 1 to 1.5 mL/kg/hr in children, and many centers aim higher for high-voltage electrical injury or rhabdomyolysis. A common protocol step is to raise the LR rate by about 25% when urine output falls below target and reassess in an hour, and to lower it when output stays above target; your facility’s protocol sets the actual step. Giving more than the patient needs is common enough to have a name, “fluid creep.” 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 — and sometimes substantially more, so titrate to urine output rather than adding a fixed amount to the Parkland figure. 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.

Questions nurses ask

Sources

These are references for checking your math, not a protocol. Where your facility’s order set, nomogram or pump library says something different, follow it.

1. Baxter CR, Shires T. Physiological response to crystalloid resuscitation of severe burns. Ann N Y Acad Sci 1968;150(3):874–894. doi.org/10.1111/j.1749-6632.1968.tb14738.x
2. Pham TN, Cancio LC, Gibran NS. American Burn Association practice guidelines: burn shock resuscitation. J Burn Care Res 2008;29(1):257–266. doi.org/10.1097/BCR.0b013e31815f3876