Parkland Formula for Adults (Estimate TBSA and fluid Requirements)
Parkland Formula for Children (Estimate TBSA and fluid Requirements in Pediatric Patients)
What is the Parkland Formula?
The Parkland formula is a guideline used to calculate the volume of intravenous fluid required in the first 24 hours for patients who have sustained significant burns. It helps prevent under-resuscitation (leading to shock and organ injury) as well as over-resuscitation (which can cause complications such as compartment syndrome and pulmonary edema).
TBSA stands for Total Body Surface Area burned (partial-thickness and full-thickness burns).Body weight is in kilograms (kg).4 mL per kg per percent burn is the standard multiplier.
Distribution of Fluid
- First 8 hours: Give half of the calculated total volume (counting from the time of the burn, not from arrival to the hospital).
- Next 16 hours: Give the remaining half of the calculated total volume.
Type of Fluid
- Lactated Ringer’s (LR) is generally recommended.
- If LR is not available, other crystalloid solutions may be considered, but LR is preferred due to its electrolyte composition being closer to physiological plasma.
Important Considerations
- Ongoing Assessment: The Parkland formula is only a starting point. Actual fluid requirements must be titrated based on urine output, vital signs, and end-organ perfusion.
- Urine Output Goals: Typically, aim for:
- 0.5–1.0 mL/kg/hr in adults,
- 1.0 mL/kg/hr in children,
- Higher targets (e.g., 1–2 mL/kg/hr) if there is electrical injury or hemoglobinuria/myoglobinuria.
- Inhalation Injury: Patients with inhalation injury may require additional fluid due to capillary leak and airway edema.
- Pediatric Patients: Children have higher maintenance fluid needs and may also require dextrose-containing solutions if they are very young or have risk of hypoglycemia.
