Parkland Formula
Burn fluid volumes for the first 24 hours, with a Rule of Nines helper for %TBSA.
4 mL × 70 kg × 30% TBSA — timed from the moment of injury, not from arrival.
The Parkland formula estimates fluid for the first 24 hours after a major burn: 4 mL × body weight in kg × %TBSA burned. For a 70 kg adult with 30% TBSA that is 8,400 mL of lactated Ringer’s — half in the first 8 hours from the time of injury, the rest over the next 16.
Why a burn needs so much fluid
A large burn makes capillaries leak. Plasma moves out of the circulation into the burned and surrounding tissue, and the volume lost is far greater than the wound itself suggests, so a patient who looks stable in the first hour can be profoundly hypovolaemic by the fourth. Burn shock is a predictable consequence of the injury rather than a complication of it, which is why resuscitation starts on a formula rather than waiting for the blood pressure to fall.
The timing is the part most often got wrong. The 24-hour clock starts at the moment of injury, not at arrival in hospital. If a patient reaches the emergency department two hours after the burn, the first half of the volume still has to be delivered by the eighth hour after injury — which means it now has to run over six hours, at a correspondingly higher rate.
A starting point, not a prescription
The formula gives an estimate to begin with; it is titrated from there. The standard endpoint is urine output, usually 0.5–1.0 mL/kg/hr in an adult, and the rate is adjusted up or down against it. The American Burn Association’s Advanced Burn Life Support guidance accepts a range of 2–4 mL/kg/%TBSA for the first 24 hours, with the modified Brooke formula starting at 2 mL, and contemporary practice tends to begin at the lower end to avoid over-resuscitation. Prescribing and titration belong to a qualified professional working to local protocol.
half in the first 8 hours from the time of injury, the remaining half over the next 16 hours
- 1 Work out the burned area as a percentage. Use the Rule of Nines: for an adult, head 9%, each arm 9%, each leg 18%, front of trunk 18%, back of trunk 18%, perineum 1%.
- 2 Count only partial- and full-thickness burns. Superficial first-degree burns, such as ordinary sunburn, are excluded from the %TBSA figure.
- 3 Multiply 4 mL by weight in kilograms and by the percentage. For 70 kg and 30% TBSA: 4 × 70 × 30 = 8,400 mL over the first 24 hours.
- 4 Split the volume in half. 4,200 mL goes in over the first 8 hours, which is 525 mL/hr.
- 5 Run the second half over 16 hours. The remaining 4,200 mL over 16 hours is about 263 mL/hr, then titrate against urine output.
Rule of Nines — adult
Each region is a percentage of total body surface area; the regions listed sum to 100%.
| Region | % TBSA |
|---|---|
| Head and neck | 9% |
| Each arm | 9% (18% both) |
| Anterior trunk | 18% |
| Posterior trunk | 18% |
| Each leg | 18% (36% both) |
| Perineum | 1% |
Worked volumes at 4 mL/kg/%TBSA
Total for the first 24 hours, with the first-8-hour rate measured from the time of injury.
| Weight | %TBSA | 24-hour total | First 8 hours |
|---|---|---|---|
| 70 kg | 20% | 5,600 mL | 350 mL/hr |
| 70 kg | 30% | 8,400 mL | 525 mL/hr |
| 80 kg | 40% | 12,800 mL | 800 mL/hr |
| 60 kg | 25% | 6,000 mL | 375 mL/hr |
| 90 kg | 50% | 18,000 mL | 1,125 mL/hr |
Where the estimate goes wrong
Over-estimating the burned area is the commonest error, and it compounds: every extra percentage point adds 4 mL per kilogram. Including superficial burns, or applying the adult Rule of Nines to a small child, both inflate the figure. Children have proportionally larger heads and smaller legs, so paediatric burns use the Lund and Browder chart rather than the adult nines.
Over-resuscitation carries its own harm — oedema, compartment syndrome and pulmonary complications — which is the reason modern guidance starts lower and titrates. The formula covers crystalloid for the first 24 hours only; it says nothing about maintenance fluid in children, colloid in the second 24 hours, or analgesia, and it does not replace assessment of the airway in an inhalation injury.