Parkland formula (burns)
Initial 24-hour crystalloid estimate in major burns
Sources last checked: 2026-10-13
Parkland formula (burns)
Initial 24-hour crystalloid estimate in major burns
A starting estimate, not a prescription. The EBA guideline recommends 2–4 mL/kg/% TBSA, titrated hourly to urine output (≈ 0.5 mL/kg/h in adults) and haemodynamics; fluid creep (over-resuscitation) is a recognised harm. In children, maintenance fluid is not included in the formula.
What is the Parkland formula (burns)?
The Parkland formula estimates crystalloid volume for the first 24 hours after a major burn: 4 mL per kg body weight per percent total body surface area (TBSA) burned. Baxter and Shires described it in 1968 from studies at Parkland Memorial Hospital, Dallas. Half the volume is traditionally given in the first 8 hours after injury and the rest over the next 16.
When to use it
- Initial fluid planning in adults with burns above about 20 % TBSA (EBA guideline threshold)
- Children with burns above about 10 % TBSA, in addition to maintenance fluids
- Checking whether a running resuscitation is far above or below the expected range
When not to use it
- Superficial (erythema-only) burns — they are excluded from TBSA
- As a fixed prescription once urine output and haemodynamic targets are available
- Electrical or inhalation injuries without adjustment — these often need more fluid
How it is calculated
Volume (mL, first 24 h) = 4 mL × body weight (kg) × % TBSA burned. Half in the first 8 hours after the burn, the other half over the next 16 hours.
Clinical pearls and limitations
- A starting estimate, not a prescription. The EBA guideline recommends 2–4 mL/kg/% TBSA, titrated hourly to urine output (≈ 0.5 mL/kg/h in adults) and haemodynamics; fluid creep (over-resuscitation) is a recognised harm. In children, maintenance fluid is not included in the formula.
- Time runs from the moment of injury, not from arrival, so the first 8-hour period includes the pre-hospital phase.
- The European Burns Association recommends 2–4 mL/kg/% TBSA in the first 24 h, titrated to urine output (≈ 0.5 mL/kg/h in adults).
- Over-resuscitation ("fluid creep") is associated with compartment syndromes and pulmonary oedema.
- TBSA is commonly overestimated by referring teams; the Lund–Browder chart is the more precise method of estimation.
Frequently asked questions
How do you calculate the Parkland formula?
4 mL × weight (kg) × % TBSA burned = total crystalloid for 24 h; the formula allocates half to the first 8 h from the time of burn.
Do first-degree burns count in the Parkland formula?
No. Only partial- and full-thickness burns are included in the TBSA.
Which fluid is used?
A balanced crystalloid such as Ringer's lactate; the EBA guideline advises against 0.9 % saline as first-line resuscitation fluid.
Evidence and guidelines
- Primary source: Baxter CR, Shires T. Physiological response to crystalloid resuscitation of severe burns. Ann N Y Acad Sci 1968;150(3):874-894.
- European Burns Association. European Practice Guidelines for Burn Care, version 4 (2017) — start resuscitation for burns > 20 % TBSA in adults and > 10 % in children; 2–4 mL/kg/% TBSA in the first 24 h, titrated to urine output.
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