Calculate an initial burn-fluid worksheet using the Parkland formula with Rule of Nines TBSA estimation, delayed presentation adjustment, and pediatric context.
The Parkland formula (also called the Baxter formula) is one of the best-known starting frameworks for early burn-fluid planning. It estimates the first 24-hour Lactated Ringer's volume as 4 mL × body weight (kg) × percent total body surface area (%TBSA) burned and is commonly taught alongside Advanced Trauma Life Support (ATLS) and burn-center practice.
The classic worksheet split places half of that 24-hour total in the first 8 hours from the time of injury and the remaining half over the next 16 hours. That front-loaded structure reflects the early capillary-leak phase, but real burn-fluid planning still depends on urine output, burn-center practice, and the evolving bedside picture rather than on a single fixed rate.
This calculator supports three starting formulas (Parkland, Modified Brooke, and ABA Consensus), offers both direct TBSA entry and interactive Rule of Nines body mapping with age-adjusted percentages, handles delayed presentation by showing how the original 8-hour window changes, and includes pediatric maintenance-fluid context using the Holliday-Segar method. The result is best used as a starting worksheet rather than as a stand-alone burn-resuscitation protocol.
Burn resuscitation errors usually come from getting the TBSA or timing wrong, not from the multiplication itself. This calculator keeps the burn size, formula choice, delayed-presentation adjustment, and urine-output targets together so the fluid plan can be checked against the actual clinical situation instead of treated as a fixed number.
Parkland: Total 24h Fluid (mL) = 4 × Weight (kg) × %TBSA burned. Classic worksheet split: first 8 hours from injury = 50% of total; next 16 hours = remaining 50%. Modified Brooke: 2 mL/kg/%TBSA. Many burn teams compare these starting figures with urine-output context of 0.5 mL/kg/hr (adults) or 1 mL/kg/hr (children).
Result: 8,400 mL total over 24 hours; First 8h: 525 mL/hr; Next 16h: 263 mL/hr
A 70 kg adult with 30% TBSA burns: 4 × 70 × 30 = 8,400 mL LR over 24 hours. First 8 hours: 4,200 mL at 525 mL/hr. Next 16 hours: 4,200 mL at 263 mL/hr. The worksheet urine-output context is 35 mL/hr (0.5 mL/kg/hr), but the bedside plan still depends on ongoing reassessment.
Modern burn resuscitation began in the 1940s-1960s following catastrophic fires (Cocoanut Grove, 1942) that demonstrated the lethal consequences of hypovolemic burn shock. Early formulas used plasma (Evans formula, 1952) and various crystalloid-colloid combinations (Brooke formula, 1953). Charles Baxter developed the Parkland formula at Parkland Memorial Hospital in the 1960s-70s, demonstrating that crystalloid alone could effectively resuscitate burn shock in the first 24 hours. The simplicity and effectiveness of the Parkland formula made it the global standard.
Despite the Parkland formula calculating 4 mL/kg/%TBSA, actual volumes administered often reach 5-8 mL/kg/%TBSA — a phenomenon called "fluid creep" documented by Pruitt in 2000. Causes include early aggressive starts before adequate monitoring, opioid use masking urine-output assessment, repeated rate increases without enough reassessment, and transient hypotension being answered with cumulative fluid boluses. Consequences include abdominal compartment syndrome (bladder pressures >25 mmHg), extremity compartment syndromes requiring fasciotomy in unburned limbs, pulmonary edema, and graft failure from edema. That history is one reason modern burn care treats formula outputs as a starting frame that must be checked against urine output and the broader bedside picture.
Inhalation injury occurs in ~10-20% of burn admissions but is present in ~60-80% of burn fatalities, making it the strongest single predictor of mortality. It increases fluid requirements by 30-50% due to increased pulmonary capillary permeability and systemic inflammation. Diagnosis is clinical (singed nasal hairs, carbonaceous sputum, stridor, facial burns in enclosed-space fire) and may later be confirmed with bronchoscopy. The practical point for this worksheet is simpler: suspected inhalation injury often makes the usual formula total less reliable on its own, so the fluid estimate needs even closer comparison with the airway picture and the center-specific burn pathway.
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This page applies the chosen burn-resuscitation formula to body weight and percent TBSA, then splits the first 24-hour total according to the classic early-and-late timing windows measured from the time of injury. It can also add pediatric maintenance-fluid context and delayed-presentation timing so the worksheet reflects how much of the original first-8-hours window has already passed.
The result is a starting estimate, not a burn-resuscitation order set. Urine output, hemodynamics, inhalation injury, age, burn-center practice, and the broader bedside picture still determine how the actual fluid plan is adjusted.
The inflammatory response and capillary leak begin at the moment of burn injury, not at hospital arrival. If a patient reaches care 3 hours after injury, the original first-8-hours window has already used 3 of those hours, so the worksheet compresses the same front-half volume into the remaining 5 hours. That is why the time of injury matters when a team compares the formula output with the bedside plan.
Fluid creep refers to volumes that significantly exceed the initial formula estimate. Over-resuscitation increases edema-related complications such as compartment syndromes and pulmonary edema. That is why this page treats the formula as a starting estimate rather than the final answer.
The Modified Brooke formula (2 mL/kg/%TBSA) gives a lower starting volume than Parkland. Some burn centers compare it with Parkland when they want a less aggressive initial estimate, particularly in larger burns where fluid creep is a concern. In practice, many real fluid totals land somewhere between those reference points, which is why the ABA Consensus range (2-4 mL/kg/%TBSA) exists.
The standard adult Rule of Nines overestimates extremity and underestimates head surface area in children. Pediatric modifications: infants have an 18% head (vs 9% adult) and smaller legs (14% each vs 18%). The Lund-Browder chart is most accurate for children, adjusting percentages by age at 1, 5, 10, and 15 years. Alternatively, the child's palm (including fingers) represents approximately 1% TBSA — useful for scattered burns. Only count partial-thickness (second-degree) and full-thickness (third-degree) burns in TBSA — superficial (first-degree) burns are excluded from fluid calculations.
This remains debated. The original Parkland formula uses only crystalloid for the first 24 hours, adding colloid (5% albumin) in hours 24-48. The rationale: capillary leak in the first 8-12 hours means colloid leaks into interstitial space and is wasted. However, some burn centers now give albumin rescue at 12-24 hours if crystalloid requirements exceed 6 mL/kg/%TBSA — evidence suggests this reduces total fluid volumes and edema. The ISBI (International Society for Burn Injuries) guidelines support early colloid in large burns. Modified Brooke originally included colloid (0.5 mL/kg/%) in the first 24 hours but the modified version dropped it.
The ABA criteria for burn center referral include: ≥10% TBSA partial-thickness burns; any full-thickness burns; burns to face, hands, feet, genitalia, perineum, or major joints; electrical or chemical burns; inhalation injury; burns in patients with significant comorbidities; burns with concomitant trauma where the burn is the greater risk; burns in children at hospitals without qualified pediatric expertise; and patients requiring special social, emotional, or rehabilitative support. These are framework triggers, not a substitute for local transfer judgment.