What it is
The Parkland (Baxter) formula estimates the crystalloid volume needed in the first 24 hours after a significant thermal burn, to replace the massive fluid shifts driven by capillary leak. It is a starting estimate, not a prescription — the resulting rate is then titrated against urine output and clinical response.
The formula
Total 24-h volume (mL) = 4 × weight (kg) × %TBSA burned
- Use Lactated Ringer’s (Hartmann’s) crystalloid.
- Count partial- and full-thickness burn only — exclude simple erythema/superficial burns.
- Give half in the first 8 hours, the remaining half over the next 16 hours.
- The clock starts at the time of injury, not the time of presentation — subtract any time already elapsed when setting the rate.
When to use it
For burns roughly ≥ 15% TBSA in adults and ≥ 10% in children, which is the threshold for formal IV fluid resuscitation. Estimate %TBSA with the Lund-Browder chart (most accurate, especially in children) rather than the adult Rule of Nines, since children have proportionally larger heads and smaller legs.
Worked example
A 20 kg child with 30% TBSA burns:
- Total 24-h = 4 × 20 × 30 = 2400 mL Lactated Ringer’s.
- First 8 h = 1200 mL → 150 mL/hr.
- Next 16 h = 1200 mL → 75 mL/hr.
- Plus maintenance fluid on top (see below), and the clock runs from the burn time.
Pitfalls and caveats
- Children need maintenance fluid added separately. Parkland alone under-resuscitates small children, who have limited glycogen stores; add maintenance fluid containing dextrose (e.g. Holliday-Segar) on top of the Parkland volume. Many pediatric burn centres prefer the Galveston formula (based on body surface area) for this reason.
- It is an estimate, not a target. Titrate to urine output ~1 mL/kg/hr in children (0.5 mL/kg/hr in adults); reduce the rate if output is high, increase if oliguric.
- Beware over-resuscitation (“fluid creep”) — excess volume causes oedema, compartment syndrome and ARDS. Modern practice often starts at the lower end and titrates up.
- The TBSA must be accurate. Over-estimation (counting erythema, or eyeballing) is the commonest source of error and drives dangerous over-filling.
Run it: Burns Fluid Resuscitation (Parkland)
Decision support for qualified clinicians only — verify against current primary guidelines and your clinical judgement.