Loading...
Printed on 6/29/2026
For informational purposes only. This is not medical advice.
The Parkland formula (also called the Baxter formula) is the most widely used method for calculating initial fluid resuscitation in burn patients. It estimates the total volume of crystalloid (typically Lactated Ringer's) needed in the first 24 hours: 4 mL × body weight (kg) × %TBSA burned. Half is given in the first 8 hours (from time of injury), and the remaining half over the next 16 hours. The formula provides a starting estimate — actual fluid administration should be titrated to urine output (0.5–1 mL/kg/hr in adults). Estimate burn surface area first with [Rule of Nines Calculator](/tools/rule-of-nines) or [Burns BSA Calculator](/tools/burns-bsa). Monitor hemodynamic response with [MAP Calculator](/tools/map-calculator). Assess overall severity and organ dysfunction with [SOFA Score](/tools/sofa-score) and [APACHE II](/tools/apache-ii).
Formula: Total crystalloid = 4 mL × weight (kg) × %TBSA. Half in first 8 hours, half in next 16 hours.
Save your results with a free account
Keep a history of calculations, favorite tools, and access your dashboard anytime.
Estimate total body surface area (TBSA) burned using the Rule of Nines: head + neck = 9%, each arm = 9%, each leg = 18%, anterior trunk = 18%, posterior trunk = 18%, perineum = 1%. EXCLUDE superficial/first-degree burns (sunburn-like redness only) — count only partial-thickness (blistering) and full-thickness burns. For irregular burns or pediatric patients, use the Lund-Browder chart for more accurate TBSA estimation. Overestimating TBSA leads to over-resuscitation ('fluid creep').
Total Lactated Ringer's for first 24 hours = 4 × weight (kg) × %TBSA burned. Example: 70 kg patient with 30% TBSA burns = 4 × 70 × 30 = 8,400 mL in 24 hours. Note: Modified Brooke formula uses 2 mL/kg/%TBSA (half the volume) — an alternative endorsed by some burn centers for lower fluid volumes. Always use Lactated Ringer's solution (NOT normal saline — hyperchloremic acidosis risk).
Administer the first 50% of the 24-hour volume in the first 8 hours from the TIME OF BURN INJURY (not from hospital arrival). If the patient arrives 3 hours after injury, the first 50% must be given in the next 5 hours. The remaining 50% is given over hours 9–24. This is a starting rate, not a rigid prescription — titrate infusion rate to maintain urine output 0.5–1.0 mL/kg/h in adults (1–2 mL/kg/h in children). Insert urinary catheter for all major burns.
Emergency physicians, burn surgeons, trauma teams
Apply the Parkland formula immediately upon presentation of major burns (>20% TBSA adults, >10% TBSA children). Calculate total 24-hour volume, determine how many hours have elapsed since burn, and set initial fluid rate accordingly. Burns >20% TBSA in adults should be referred to a burn center — initiate Parkland resuscitation during transfer.
Burn center surgeons, ICU nurses, burn teams
Burn center teams use the Parkland formula as the starting framework, adjusting fluids based on hourly urine output monitoring, hemodynamic response, and physical examination. Serial abdominal examinations for compartment syndrome, bladder pressure monitoring, and chest X-rays guide fluid adjustment in major burns. Goal: urine output 0.5–1.0 mL/kg/h without over-resuscitation.
Disaster medicine teams, mass casualty coordinators
In mass casualty incidents with multiple burn victims, Parkland formula provides rapid, standardized fluid volume calculations for resource allocation and prioritization. ABA burn center transfer criteria (>20% TBSA, >10% TBSA in children, facial/hand/foot/perineal burns, electrical, chemical, or inhalation injury) guide triage decisions alongside fluid calculation.
Pediatric surgeons, pediatric ICU teams
For children under 20 kg, the Galveston formula adds a maintenance component: 5,000 mL/m² burned/day + 2,000 mL/m² total BSA/day. The standard Parkland formula underestimates fluid needs in small children due to their higher body surface area-to-weight ratio. Always use the Galveston formula or a pediatric-adjusted formula for children — do not apply adult Parkland directly.
Paramedics, pre-hospital trauma teams
Pre-hospital calculation of Parkland formula allows early fluid initiation and accurate transport-to-burn-center communication. Paramedics who estimate TBSA and establish large-bore IV access with Lactated Ringer's starting at 500 mL/h (or calculated rate) improve outcomes in major burns. Pre-alert the receiving burn center with TBSA estimate, weight, and time of injury.
Burn center intensivists, critical care nurses
Over-resuscitation ('fluid creep') is a major complication of rigid Parkland formula adherence, causing abdominal compartment syndrome, pulmonary edema, and extremity compartment syndrome. Monitor bladder pressure (>20 cmH₂O warrants concern), chest X-ray, and respiratory compliance. Reduce fluid rate if UO exceeds 1.5 mL/kg/h. Colloids (albumin) added at 8–24h may reduce total crystalloid requirements.
This is the most common and most dangerous error in Parkland formula administration. If a patient burned at 1:00 PM and arrives at 3:00 PM, the first 50% of volume must be given by 9:00 PM (8 hours after the burn), NOT by 11:00 PM (8 hours after arrival). At arrival, calculate how many hours remain in the first 8-hour window and adjust the infusion rate accordingly. Always document time of injury clearly.
First-degree burns (superficial epidermal injury causing redness only, like mild sunburn) are excluded from TBSA calculation. Only partial-thickness (blistering, painful, moist) and full-thickness (leathery, insensate) burns are included. Including first-degree burns inflates TBSA and leads to dangerous over-resuscitation. Re-evaluate TBSA after eschar separation to confirm initial estimate.
The Parkland formula provides a STARTING volume estimate. Actual fluid administration must be continuously titrated to urine output (target 0.5–1.0 mL/kg/h in adults). Under-resuscitation (UO <0.5 mL/kg/h): increase rate 20%. Over-resuscitation (UO >1.5 mL/kg/h): decrease rate 20%. Mechanical adherence to the formula without UO monitoring is the primary cause of fluid creep. Insert urinary catheter in all burns >20% TBSA.
Patients with inhalation injury require 30–50% more fluid than the Parkland formula predicts. Signs of inhalation injury: singed nasal hairs, carbonaceous sputum, stridor, facial burns, hoarse voice, elevated carboxyhemoglobin, or fire in an enclosed space. These patients require early intubation (airway swelling can be rapid) and higher fluid rates. Adjust Parkland estimate upward accordingly.
The Modified Brooke formula uses half the Parkland volume: 2 mL/kg/%TBSA LR in the first 24 hours. Some burn centers prefer Modified Brooke to reduce total crystalloid and fluid creep risk. Both formulas are endorsed by the ABA. The choice depends on institutional preference and patient factors. Regardless of starting formula, always titrate to urine output.
ABA burn center transfer criteria: burns >20% TBSA in adults, >10% TBSA in children, burns involving face/hands/feet/genitalia/perineum, circumferential burns, full-thickness burns >5% TBSA, electrical burns (including lightning), chemical burns, burns with inhalation injury, or burns in patients with significant comorbidities. Initiate Parkland resuscitation before and during transfer.
After the first 8 hours, capillary integrity begins to recover and colloid administration becomes more effective. Many burn centers add albumin (5%) at 8–24 hours to maintain colloid oncotic pressure and reduce ongoing crystalloid needs. Some centers use a 'colloid supplement protocol' to add albumin when total Parkland volume exceeds predicted. This practice reduces total fluid volume and edema complications.
Major burns cause prolonged intestinal ileus. Insert a nasogastric tube for burns >20% TBSA to decompress the stomach, start early enteral nutrition (within 6 hours if possible), and prevent aspiration. Early enteral nutrition in major burns is associated with reduced catabolism, improved wound healing, and lower infection rates. Parenteral nutrition is reserved for patients who cannot tolerate enteral feeds.
Circumferential full-thickness burns of the extremities or chest can cause compartment syndrome as edema progresses during resuscitation. Monitor limb compartment pressures, capillary refill, pulses (Doppler), and neurological status. Escharotomy (surgical release of burn eschar) is indicated for compartment pressures >30 mmHg or absent Doppler signals. Chest escharotomy may be needed for circumferential chest burns causing respiratory restriction.
Parkland Formula developed by Baxter and Shires (J Trauma 1968). Original formula: 4 mL/kg/%TBSA LR in first 24 hours. Modified Brooke (2 mL/kg/%TBSA) is an alternative. ABA (American Burn Association) Practice Guidelines endorse Parkland or Modified Brooke formulas with hourly UO titration. Fluid creep complications reviewed by Pham et al. (J Burn Care Res 2008). Pediatric modifications: Galveston formula adds maintenance fluid.
Your result provides the estimated total crystalloid volume (typically Lactated Ringer's solution) required for the first 24 hours following a significant burn injury. The total volume is divided into two phases: half should be administered in the first 8 hours from the time of injury (not from hospital arrival), and the remaining half should be infused over the subsequent 16 hours. For example, if the calculated total is 8,400 mL, the target rate for the first 8 hours would be approximately 525 mL/hr, followed by approximately 263 mL/hr for the next 16 hours.
This calculated volume is a starting point, not a fixed prescription. Actual fluid administration must be continuously titrated based on the patient's urine output (target 0.5–1.0 mL/kg/hr in adults, 1–2 mL/kg/hr in children), hemodynamic status, and clinical response. Both under-resuscitation and over-resuscitation carry significant risks.
Use the Parkland formula for initial fluid resuscitation planning in adult patients with burns exceeding 20% total body surface area (TBSA) and in children with burns exceeding 10% TBSA. These are the thresholds at which formal IV fluid resuscitation is generally required. Smaller burns are typically managed with oral hydration alone.
The formula should be applied as soon as possible after injury — ideally during the initial assessment and stabilization of the burn patient. It is a standard component of burn center admission protocols, emergency department burn management, and pre-hospital care planning for major burns. The formula is also applicable during interfacility transfer when calculating fluid rates for transport.
The Parkland formula is an estimate based on weight and burn surface area alone. It does not account for inhalation injury, electrical burns, or delayed presentations, all of which may require significantly more fluid than predicted. Patients with inhalation injury, for example, may need 30–40% more fluid than the formula suggests.
The formula also does not account for patient-specific factors such as pre-existing cardiac or renal disease, which may limit the ability to tolerate large-volume resuscitation. Over-resuscitation (sometimes called "fluid creep") is a recognized complication that can lead to abdominal compartment syndrome, pulmonary edema, and extremity compartment syndrome. The %TBSA estimate itself introduces error — inaccurate burn size assessment directly impacts the calculated volume. The Rule of Nines or Lund-Browder chart should be used carefully for TBSA estimation.
Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.
April 21, 2026 · trust-baseline
Clinical trust metadata enabled for this tool page with structured review/version fields.
Estimate total body surface area (TBSA) affected by burns using the Rule of Nines. Enter affected areas to calculate total burn percentage. Then use TBSA result in [Parkland Formula](/tools/parkland-formula) for fluid resuscitation.
OpenDermatologyEstimate total body surface area (TBSA) burned using the Rule of Nines. Head=9%, each arm=9%, each leg=18%, torso=36%. Burns ≥20% TBSA require IV fluid resuscitation with the Parkland formula.
OpenEmergencyCalculate the Revised Trauma Score (RTS) for trauma triage and survival prediction. Combines GCS, systolic BP, and respiratory rate. Maximum score 7.84; RTS <4 predicts high mortality.
Open