Emergency Medicine
Parkland Formula (Burns)
24-hour fluid resuscitation in burns.
Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.
Background
The Parkland formula estimates the volume of intravenous crystalloid needed for fluid resuscitation in the first 24 hours after a significant burn. It calculates total fluid as 4 mL multiplied by body weight in kilograms and the percentage of total body surface area (TBSA) burned. Only second-degree (partial-thickness) and deeper burns are included in the TBSA estimate. The result is a starting estimate, expressed in millilitres over 24 hours, that must then be titrated to the patient's response.
Interpreting the result
Half of the calculated total is given over the first 8 hours, timed from the moment of injury rather than from arrival, and the remaining half over the next 16 hours. The volume is then adjusted — most importantly to urine output — because the formula only provides a starting point and over- or under-resuscitation is common. Burns resuscitation should be undertaken with senior and burns-unit input, and large or complex burns require specialist transfer. The calculated figure is an estimate, not a prescription.
Worked example
An adult weighing 70 kg with a 30% TBSA burn requires 4 × 70 × 30 = 8400 mL over 24 hours. Half (4200 mL) is given in the first 8 hours from the time of injury and the remainder over the following 16 hours, with the rate adjusted to maintain adequate urine output.
Critical actions
Total = 4 mL × weight × %TBSA over 24h; give HALF in the first 8 hours from the time of injury, the rest over the next 16h. Titrate to urine output; this is a starting estimate only.
Pearls / pitfalls
- Start the 24-hour clock from the time of injury, not from hospital arrival — time already elapsed must be accounted for.
- Only partial-thickness and deeper burns count towards TBSA; superficial (erythema only) burns are excluded.
- It is a starting estimate; resuscitation is titrated to urine output and clinical response to avoid over-resuscitation and its complications.
- Large, deep or special-site burns need early discussion with a burns unit and senior involvement; the formula does not replace specialist care.
Evidence & validation
Based on the crystalloid resuscitation work of Baxter and Shires and long established in burns care. It is reflected in burns-resuscitation protocols internationally, including those of major burns associations, always with the caveat that fluids are titrated to physiological endpoints.
Frequently asked questions
When does the 24-hour period start?
It starts from the time of the burn injury, not from arrival at hospital. Any fluid already given and time elapsed must be subtracted when planning the resuscitation.
Which burns count towards the TBSA?
Only partial-thickness (second-degree) and deeper burns are included. Superficial burns with erythema alone are not counted, as including them would over-estimate the fluid requirement.
Is the calculated volume a fixed prescription?
No. It is only a starting estimate. The actual rate is titrated to physiological endpoints, principally urine output, because the formula commonly over- or under-estimates the true requirement.
How is urine output used?
Urine output is the main marker of adequate resuscitation, and the fluid rate is increased or decreased to keep it within a target range. This guards against both under-resuscitation and harmful fluid overload.
Does Parkland apply to children?
Children have different fluid requirements and may need maintenance fluid in addition to resuscitation fluid, calculated using paediatric-specific approaches. Paediatric burns should involve specialist and burns-unit input.
References
- Baxter CR, Shires T. Physiological response to crystalloid resuscitation of severe burns. Ann N Y Acad Sci. 1968;150(3):874–894.
- ISBI Practice Guidelines Committee. ISBI Practice Guidelines for Burn Care. Burns. 2016;42(5):953–1021.
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