Calculate Total 24-Hour Fluid Volume
70kg adult, 30% TBSA, 1 hour post-burn
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Evidence-based calculations Used in clinical settings worldwide Regular monitoring recommended
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Moderate Burn
70kg adult, 30% TBSA, 1 hour post-burn
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Major Burn
80kg adult, 50% TBSA, 2 hours post-burn
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Burn + Inhalation
75kg adult, 40% TBSA with smoke inhalation
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Pediatric Burn
20kg child, 25% TBSA
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Delayed Presentation
65kg adult, 35% TBSA, 4 hours post-burn
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Clinical Scenarios
Select a burn scenario to load parameters:
Moderate Burn
70kg adult, 30% TBSA, 1 hour post-burn
House fire, no inhalation injury
Major Burn
80kg adult, 50% TBSA, 2 hours post-burn
Industrial accident, stable vitals
Burn + Inhalation
75kg adult, 40% TBSA with smoke inhalation
Enclosed space fire, intubated
Pediatric Burn
20kg child, 25% TBSA
6-year-old scald injury
Delayed Presentation
65kg adult, 35% TBSA, 4 hours post-burn
Transfer from outside hospital
Patient Information
Clinical Factors
Resuscitation Plan
| Period | Volume | Rate |
| First 8 Hours | 4200 mL | 525 mL/hr |
| Next 16 Hours | 4200 mL | 263 mL/hr |
| Adjusted Now | Remaining | 600 mL/hr |
- If UOP < 0.5 mL/kg/hr: Increase rate by 20%
- If UOP > 1 mL/kg/hr: Decrease rate by 20%
- Reassess every hour during first 24 hours
Fluid Distribution
Step-by-Step Calculations
Formula: ext{Total} = 4 ext{mL} imes ext{Weight} ( ext{kg}) imes ext{TBSA} (%)
Calculation: Total = 4 × 70 × 30
Result: 8400 mL
Formula: ext{First} 8hr = ext{Total} imes 0.5
Calculation: First 8hr = 8400 × 0.5
Result: 4200 mL
Formula: ext{Remaining} 16hr = ext{Total} imes 0.5
Calculation: Remaining 16hr = 8400 × 0.5
Result: 4200 mL
Formula: ext{Rate} = ext{First} 8hr ext{Volume} div 8 ext{hours}
Calculation: Rate = 4200 ÷ 8
Result: 525 mL/hr
Formula: ext{Rate} = ext{Remaining} 16hr ext{Volume} div 16 ext{hours}
Calculation: Rate = 4200 ÷ 16
Result: 263 mL/hr
Formula: ext{Adjusted} ext{Rate} = ( ext{First} 8hr - ext{Prior} ext{Fluids}) div ext{Remaining} ext{Time}
Calculation: Adjusted Rate = (4200 - 0) ÷ 7.0
Result: 600 mL/hr for remaining 7.0 hours
Rule of Nines - TBSA Reference
Adult TBSA
| Head/Neck | 9% |
| Each Arm | 9% |
| Anterior Trunk | 18% |
| Posterior Trunk | 18% |
| Each Leg | 18% |
| Perineum | 1% |
Pediatric TBSA Adjustments
| Head (infant) | 18% |
| Head (5 years) | 14% |
| Head (10 years) | 11% |
| Each Leg (infant) | 14% |
| Each Leg (5 years) | 16% |
What is the Parkland Formula?
The Parkland formula (also called the Baxter formula) is the standard approach for calculating initial crystalloid fluid resuscitation in burn patients. Developed by Dr. Charles Baxter at Parkland Hospital in Dallas, it guides the volume and rate of fluid replacement in the critical first 24 hours following a significant burn injury.
Burn Resuscitation
Burns cause massive fluid shifts from intravascular to interstitial spaces. The Parkland formula replaces this lost volume to prevent hypovolemic shock.
Time-Based Delivery
50% of fluid is given in the first 8 hours (from time of burn), when capillary leak is most severe. The remaining 50% is given over the next 16 hours.
Titration Goal
The formula is a starting point. Fluids are titrated to maintain adequate urine output (0.5-1 mL/kg/hr in adults) as the primary endpoint.
How Does the Parkland Formula Work?
The Formula
First 8 Hours: 50%
Half of total volume, starting from time of burn
Next 16 Hours: 50%
Remaining half at lower rate
Example Calculation
Given:
- • 70 kg adult
- • 30% TBSA burn
- • Presentation 1 hour post-burn
Solution:
Total = 4 × 70 × 30 = 8,400 mL
First 8hr = 4,200 mL at 525 mL/hr
Next 16hr = 4,200 mL at 263 mL/hr
When to Use the Parkland Formula
Burns >20% TBSA (Adults)
Aggressive fluid resuscitation indicated for adults with significant burn surface area.
Burns >10% TBSA (Children)
Lower threshold for pediatric patients due to smaller circulating volumes.
Inhalation Injury
Patients with smoke inhalation often require 20-50% more fluid than calculated.
Electrical Burns
Visible burns may underestimate injury. Often need more fluids and monitor for myoglobinuria.
First 24 Hours
Parkland applies to the initial resuscitation phase. After 24 hours, different formulas apply.
Burn Center Transfer
Use Parkland to guide resuscitation until transfer to definitive burn care.
TBSA Estimation - Rule of 9s
| Body Region | Adult %TBSA | Child (1-4 yrs) | Infant (<1 yr) |
| Head/Neck | 9% | 17% | 18% |
| Each Arm (entire) | 9% | 9% | 9% |
| Anterior Trunk | 18% | 18% | 18% |
| Posterior Trunk | 18% | 18% | 18% |
| Each Leg (entire) | 18% | 14% | 14% |
| Perineum | 1% | 1% | 1% |
Burn Depth Classification
| Degree | Depth | Appearance | Sensation | Healing |
| Superficial (1st) | Epidermis only | Dry, red, no blisters | Painful | 3-5 days, no scar |
| Superficial Partial (2nd) | Papillary dermis | Wet, blisters, pink/red | Very painful | 7-14 days, minimal scar |
| Deep Partial (2nd) | Reticular dermis | Wet/waxy, white/red mottled | Pressure only | 3+ weeks, scarring likely |
| Full Thickness (3rd) | Entire dermis | Dry, leathery, white/brown/black | Insensate | Requires grafting |
| 4th Degree | Subcutaneous, muscle, bone | Charred, eschar | Insensate | Amputation may be needed |
Resuscitation Endpoints
| Adults | 0.5-1.0 mL/kg/hr |
| Children (<30 kg) | 1.0 mL/kg/hr |
| Electrical/Crush Injury | 1.5-2.0 mL/kg/hr |
- • Heart rate <120 bpm in adults
- • Mean arterial pressure >60 mmHg
- • Base deficit improving
- • Lactate clearing
- • Mental status improving
Burn Resuscitation Formulas
1. Parkland Formula (Standard)
50% in first 8hr (from burn time), 50% over next 16hr
2. Modified Brooke Formula
Alternative formula using less crystalloid; may add colloid
3. Pediatric Maintenance Addition
Children need glucose-containing maintenance fluids in addition to resuscitation
4. Rate Adjustment Formula
Increase by 20% if urine output <0.5 mL/kg/hr; decrease if >1 mL/kg/hr
Frequently Asked Questions
Why Lactated Ringers and not Normal Saline?
LR is preferred because large volumes of NS can cause hyperchloremic metabolic acidosis. LR's composition is closer to plasma. However, NS is acceptable if LR is unavailable.
What if the patient arrives late?
The "first 8 hours" is measured from time of burn, not arrival. If presenting 4 hours post-burn, give the remaining first-8-hour volume over the remaining 4 hours (not 8 hours).
Should colloids be added?
Crystalloid alone is standard for the first 24 hours. Colloids (albumin) may be considered after 12-24 hours if resuscitation volumes are excessive (>6 mL/kg/%TBSA).
What about fluid creep?
"Fluid creep" refers to the tendency to give more fluid than calculated. Over-resuscitation increases risks of abdominal compartment syndrome, pulmonary edema, and death. Titrate to urine output, not arbitrary targets.
When should I consult a burn center?
ABA criteria include: >10% TBSA in children/elderly, >20% in adults, third-degree burns >5%, burns involving face/hands/feet/genitalia/joints, electrical/chemical burns, inhalation injury, and burns in patients with significant comorbidities.
Clinical Pearls
Golden Hour
Early, aggressive resuscitation improves outcomes. Establish IV access and start fluids within 1 hour of burn.
Foley Catheter Essential
Hourly urine output is the primary resuscitation endpoint. Place Foley early in any significant burn.
Don't Over-Resuscitate
Target UOP 0.5-1 mL/kg/hr. More is not better - excessive fluids cause compartment syndrome and pulmonary edema.
Inhalation Multiplier
Patients with inhalation injury typically need 20-50% more fluid. Watch for signs: facial burns, singed nasal hairs, carbonaceous sputum.
For informational purposes only — not medical advice. Consult a healthcare professional before acting on results.
🏥 Health Facts
— WHO
— CDC
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