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The Parkland Formula provides initial fluid resuscitation estimates for burn patients. This is a STARTING POINT only. Actual fluid requirements must be titrated to clinical endpoints (urine output 0.5-1 mL/kg/hr adults, 1 mL/kg/hr children). Over-resuscitation causes complications. Under-resuscitation causes shock and organ failure. Close monitoring and frequent reassessment are essential.
Calculate fluid resuscitation requirements for burn patients
Use Rule of Nines or Lund-Browder chart
Enter time since burn to calculate remaining fluid needed (useful for delayed presentations)
Total Fluid (24h) = 4 mL × Weight (kg) × %TBSA
The Parkland Formula, developed at Parkland Memorial Hospital in Dallas in the 1960s-70s, revolutionized burn care by providing a standardized approach to fluid resuscitation. It addresses the massive capillary leak and fluid shifts that occur in major burn injuries.
The coefficient "4" represents the average volume of crystalloid needed to maintain adequate perfusion during the first 24 hours. Some patients need more (inhalation injury, delayed resuscitation, electrical burns), others less (elderly, cardiac disease).
The first 8 hours post-burn represent the period of greatest capillary leak and fluid requirements. Front-loading resuscitation during this critical window prevents shock and maintains organ perfusion during peak fluid shifts.
Giving excessive fluids beyond urine output targets causes complications:
Inadequate fluid administration leads to:
Once capillary leak resolves (typically after 8-24 hours), consider adding colloid (albumin):
| Parameter | Target | Frequency |
|---|---|---|
| Urine Output | 0.5-1 mL/kg/hr (adult) >1 mL/kg/hr (child) | Hourly |
| Heart Rate | <120 bpm | Continuous |
| Mean Arterial Pressure | ≥65 mmHg | Continuous or Q1hr |
| Mental Status | Alert & oriented | Q1-2hr |
| Base Deficit | -2 to +2 mEq/L | Q2-4hr |
| Lactate | <2 mmol/L | Q2-4hr |
| Fluid Balance | Track I/O | Q1hr |
Use Parkland for burns ≥15-20% TBSA in adults or ≥10% TBSA in children/elderly. Smaller burns may only need oral hydration or minimal IV fluids. Always assess total clinical picture.
Calculate from the time of burn injury, NOT time of arrival. If arriving 4 hours post-burn, they should have already received half of the first 8-hour volume. Calculate remaining fluid needed and administer over remaining time. May need to give fluid faster initially to "catch up."
Too low (<0.5 mL/kg/hr): Increase IV rate by 1/3. Reassess in 1 hour.Too high (>1 mL/kg/hr sustained): Decrease IV rate by 1/3. Do NOT give boluses - adjust infusion rate gradually.
Lactated Ringer's is preferred. It's more physiologic (closer to plasma composition) and reduces risk of hyperchloremic metabolic acidosis that can occur with large volumes of normal saline. NS is acceptable if LR unavailable.
Consider adding 5% albumin after 8-24 hours once capillary leak has resolved. Not all burn centers use colloid routinely. If used, typical dose is 0.3-0.5 mL/kg/%TBSA over 24 hours, with continued titration to urine output.
In children, ADD maintenance fluids (using 4-2-1 rule) to the Parkland calculation. Use D5LR (dextrose-containing solution) for maintenance to prevent hypoglycemia. Target urine output 1 mL/kg/hr in children, 2 mL/kg/hr in infants.
Use the Rule of Nines (adults) or Lund-Browder chart (children, more accurate). Count only 2nd and 3rd degree burns - do NOT count superficial (1st degree) burns. Patient's palm = ~1% TBSA. When in doubt, use burn center's assessment or dedicated TBSA calculator.
Need for vasopressors during early burn resuscitation suggests inadequate fluid resuscitation, severe inhalation injury, or other pathology (tension pneumothorax, cardiac event). Ensure adequate volume first, then consider low-dose vasopressin if needed. Avoid excessive pressors - may worsen burn depth.