What is the Parkland Formula for burns?

The Parkland Formula calculates 24-hour fluid resuscitation for burn patients: Total fluid = 4 mL × Patient weight (kg) × %TBSA burned (second and third-degree burns only). Lactated Ringer's solution is the fluid of choice. Half (50%) of the calculated volume is given in the first 8 hours from the TIME OF INJURY (not time of presentation). The remaining 50% is given over the next 16 hours. A modified Parkland uses 2 mL/kg/%TBSA for children or some adult protocols.

What is the Rule of Nines for burns?

The Rule of Nines divides the adult body surface into areas of approximately 9% each: Head and neck = 9%; Each arm = 9% (total 18%); Chest (anterior torso) = 18%; Back (posterior torso) = 18%; Each leg = 18% (total 36%); Genitalia = 1%. Total = 100%. For children, the Lund-Browder chart is more accurate because children have proportionally larger heads and smaller legs than adults. Only second-degree (partial thickness) and third-degree (full thickness) burns are included in the TBSA calculation for the Parkland Formula — first-degree (superficial/sunburn) burns are excluded.

What is the urine output target during burn resuscitation?

The urine output target during burn fluid resuscitation is 0.5–1.0 mL/kg/hour in adults — the primary endpoint for titrating fluid administration. For children weighing less than 30 kg, the target is 1 mL/kg/hour. Urine output below 0.5 mL/kg/hour indicates under-resuscitation; output above 1 mL/kg/hour with other signs of fluid overload indicates over-resuscitation. Avoid using lactate or CVP targets in isolation — urine output remains the gold standard endpoint for burn resuscitation.

Why is Lactated Ringer's preferred over Normal Saline in burns?

Lactated Ringer's (LR) is preferred over Normal Saline (NS) for burn resuscitation because: (1) LR is more physiologically balanced — pH 6.5, osmolality 273 mOsm/L, chloride 109 mEq/L versus NS chloride 154 mEq/L; (2) Large-volume NS causes hyperchloremic metabolic acidosis, which can be severe with the volumes required in major burns (often 10–20+ liters in 24 hours); (3) LR more closely matches plasma electrolyte composition; (4) All major burn guidelines (ABA, ABLS) recommend LR as the first-line resuscitation fluid in the Parkland protocol.

What is the Parkland Formula for burns?

The Parkland Formula calculates 24-hour fluid resuscitation for burn patients: Total fluid = 4 mL × Patient weight (kg) × %TBSA burned (second and third-degree burns only). Lactated Ringer's solution is the fluid of choice. Half (50%) of the calculated volume is given in the first 8 hours from the TIME OF INJURY (not time of presentation). The remaining 50% is given over the next 16 hours. A modified Parkland uses 2 mL/kg/%TBSA for children or some adult protocols.

What is the Rule of Nines for burns?

The Rule of Nines divides the adult body surface into areas of approximately 9% each: Head and neck = 9%; Each arm = 9% (total 18%); Chest (anterior torso) = 18%; Back (posterior torso) = 18%; Each leg = 18% (total 36%); Genitalia = 1%. Total = 100%. For children, the Lund-Browder chart is more accurate because children have proportionally larger heads and smaller legs than adults. Only second-degree (partial thickness) and third-degree (full thickness) burns are included in the TBSA calculation for the Parkland Formula — first-degree (superficial/sunburn) burns are excluded.

What is the urine output target during burn resuscitation?

The urine output target during burn fluid resuscitation is 0.5–1.0 mL/kg/hour in adults — the primary endpoint for titrating fluid administration. For children weighing less than 30 kg, the target is 1 mL/kg/hour. Urine output below 0.5 mL/kg/hour indicates under-resuscitation; output above 1 mL/kg/hour with other signs of fluid overload indicates over-resuscitation. Avoid using lactate or CVP targets in isolation — urine output remains the gold standard endpoint for burn resuscitation.

Why is Lactated Ringer's preferred over Normal Saline in burns?

Lactated Ringer's (LR) is preferred over Normal Saline (NS) for burn resuscitation because: (1) LR is more physiologically balanced — pH 6.5, osmolality 273 mOsm/L, chloride 109 mEq/L versus NS chloride 154 mEq/L; (2) Large-volume NS causes hyperchloremic metabolic acidosis, which can be severe with the volumes required in major burns (often 10–20+ liters in 24 hours); (3) LR more closely matches plasma electrolyte composition; (4) All major burn guidelines (ABA, ABLS) recommend LR as the first-line resuscitation fluid in the Parkland protocol.

🔥 American Burn Association · Parkland Formula · Rule of Nines · LR Protocol

Parkland Burn Formula Calculator

Calculate 24-hour Lactated Ringer's fluid resuscitation for burn patients using the Parkland Formula (4 mL × kg × %TBSA). Interactive Rule of Nines body map with Phase 1 (8h) and Phase 2 (16h) infusion rates.

NM Clinically reviewed byDr. Nikhil Mahajan, PT, MPT · Jan 15, 2025

Parkland Formula 4 mL × kg × %TBSA

Fluid of Choice Lactated Ringer's (LR)

Phase 1 (0–8h) 50% of total volume

Phase 2 (8–24h) 50% of total volume

UO Target (Adults) 0.5–1 mL/kg/hr

Timing is critical: Phase 1 begins from the TIME OF INJURY — not the time of hospital arrival. Subtract time already elapsed from injury to calculate remaining Phase 1 volume and rate.

TBSA Assessment — Rule of Nines

Tap/click body regions to mark burned areas. Only 2nd and 3rd-degree burns count. Front and back are separate. Total TBSA updates live.

TBSA 0%

Tap body regions to mark burned areas

Front

Back

Patient Parameters

Enter patient weight and select the Parkland constant (4 mL standard / 2 mL modified).

Patient Weight

Body weight in kilograms — use actual weight

Parkland Constant

4 mL Standard Parkland — ABA protocol, adults

3 mL Modified Brooke Formula

2 mL Pediatric / Modified protocol

Time of Injury (optional)

Used to calculate remaining Phase 1 time and adjusted rate

4 mL × [weight] × [TBSA%] = ? Enter weight and TBSA above

Rule of Nines — Adult vs Pediatric TBSA Reference

Body Region	Adult TBSA	Child TBSA	Notes
Head & Neck	9%	18%	Includes scalp and face
Anterior Torso (Chest)	18%	18%	Chest + abdomen, front only
Posterior Torso (Back)	18%	18%	Upper + lower back
Right Arm	9%	9%	Upper arm + forearm + hand
Left Arm	9%	9%	Upper arm + forearm + hand
Right Leg	18%	13.5%	Thigh + lower leg + foot
Left Leg	18%	13.5%	Thigh + lower leg + foot
Genitalia	1%	1%	Perineum
TOTAL	100%	100%	Only 2nd + 3rd degree burns counted

Burn Depth Classification — Which Burns Count in TBSA?

Burn Depth	Also Known As	Appearance	Sensation	Count in TBSA?
First-Degree (Superficial)	Sunburn	Red, dry, no blisters	Painful	NOT counted
Second-Degree Superficial (Partial Thickness)	Scalds	Blisters, moist, red, blanches	Very painful	Counted in TBSA
Second-Degree Deep (Partial Thickness)	Flame burns	Wet or waxy, pale/red, blisters	Reduced pain	Counted in TBSA
Third-Degree (Full Thickness)	Chemical/electrical	Leathery, white/brown/black, dry	Painless (nerve destruction)	Counted in TBSA

First-degree burns (superficial/sunburn) are NOT included in the TBSA calculation for the Parkland Formula.

Parkland Burn Formula — Clinical Reference

The Parkland Formula was developed by Charles Baxter at Parkland Memorial Hospital in Dallas in 1968 as the standard protocol for fluid resuscitation in major burns. It calculates the total Lactated Ringer's volume needed in the first 24 hours after injury: 4 mL × patient weight (kg) × %TBSA burned. Only second-degree (partial thickness) and third-degree (full thickness) burns are included in the TBSA calculation — first-degree (superficial) burns are excluded because they do not cause significant fluid losses.

Why Timing Matters — Time of Injury, Not Arrival

The 24-hour Parkland resuscitation period begins at the time of injury — not the time the patient arrives at the hospital. If a patient arrives 2 hours after the burn occurred, Phase 1 has only 6 hours remaining rather than 8. The remaining Phase 1 volume must be administered in that shorter timeframe, increasing the hourly rate. Always document the time of injury and calculate accordingly.

Rule of Nines — Practical Application

The Rule of Nines divides the adult body into regions of approximately 9% TBSA each. For irregularly shaped burns, the "palm rule" provides a quick bedside estimate: the patient's palm (including fingers) represents approximately 1% TBSA. For children, the Lund-Browder chart is more accurate because pediatric patients have proportionally larger heads and smaller legs — a 1-year-old's head represents 18% TBSA rather than 9%.

Fluid Administration — Practical Protocol

Fluid of choice: Lactated Ringer's (LR) — isotonic, more physiological than Normal Saline, prevents hyperchloremic metabolic acidosis
Phase 1 (Hours 0–8 from injury): 50% of calculated 24h volume — typically 2 mL/kg/%TBSA
Phase 2 (Hours 8–24 from injury): Remaining 50% over 16 hours — slower rate
Titration endpoint: Urine output 0.5–1.0 mL/kg/hour — increase rate if below, decrease if above
Over-resuscitation risk: "Fluid creep" — excess volume causes abdominal compartment syndrome, pulmonary edema, extremity compartment syndrome
Colloid (after 24h): Albumin 5% may be added after 24 hours to help reduce total crystalloid requirements

When to Transfer to a Burn Center

American Burn Association criteria for burn center referral include: TBSA ≥10% (any age), full-thickness burns ≥5% TBSA, burns involving face/hands/feet/genitalia/major joints, circumferential burns, inhalation injury, electrical or chemical burns, burns in patients with significant comorbidities, and burns in children or elderly patients.

NM Dr. Nikhil Mahajan, PT, MPT · Reviewed January 15, 2025 · View credentials

Frequently Asked Questions

What if a patient arrives hours after the burn injury?

Phase 1 begins at the time of injury, not hospital arrival. Subtract the elapsed time since injury from 8 hours to determine remaining Phase 1 time. Administer the full Phase 1 volume (50% of 24h total) in the remaining time — this will require a higher hourly rate. For example, if a patient arrives 3 hours post-burn: Phase 1 has 5 hours remaining. Divide Phase 1 volume by 5 (not 8) for the correct hourly rate.

Does the Parkland Formula apply to electrical burns?

The Parkland Formula underestimates fluid requirements in electrical burns because deep muscle injury (rhabdomyolysis) causes additional fluid losses not reflected in external TBSA appearance. For high-voltage electrical burns, target urine output of 1–1.5 mL/kg/hour (higher than the standard 0.5–1.0 for flame burns) to prevent myoglobin precipitation in renal tubules. Add sodium bicarbonate to the LR if urine is pigmented (myoglobinuria). The external burn surface may look minimal while the internal injury is massive.

What is "fluid creep" and why is it dangerous?

Fluid creep refers to the administration of significantly more fluid than the Parkland Formula estimates — often 1.5 to 2 times the calculated volume — a phenomenon observed in modern burn centers. It is associated with: abdominal compartment syndrome (elevated intra-abdominal pressure compressing bowel and kidneys), pulmonary edema and acute respiratory failure, extremity compartment syndrome, and worsening tissue edema. Fluid creep occurs because clinicians over-respond to single urine output readings. The solution is titrating fluid based on urine output trends, not bolusing in response to transient oliguria.

Should children use the same Parkland Formula?

Children require a modified approach: the same formula (3–4 mL/kg/%TBSA) is used, but with important modifications: (1) Use the Lund-Browder chart instead of Rule of Nines for TBSA calculation — pediatric TBSA distribution differs significantly from adults; (2) Add maintenance fluids with dextrose (D5LR) to prevent hypoglycemia — children have limited glycogen stores; (3) Target urine output 1 mL/kg/hour for children under 30 kg; (4) Monitoring for hypothermia — children lose heat rapidly through burns. Consult pediatric burn guidelines for specific weight-based protocols.