Parkland Formula & Burn Percentage Calculator
Estimate TBSA via the Rule of Nines & compute 24-Hour Fluid Resuscitation Needs
1. Patient Details
2. TBSA Burn Calculator (Rule of Nines)
Enter 1 for full area involvement, or decimals for partial (e.g., 0.5 = half the area). Exclude superficial (first-degree) burns from this assessment.
Rule of Nines Calculator — Quick Reference
This burns calculator automatically adjusts TBSA (Total Body Surface Area) percentages based on the patient's age group. Children have proportionally larger heads and smaller legs compared to adults.
| Body Region | Adult % TBSA | Infant/Child % TBSA |
|---|---|---|
| Head & Neck | 9% | 18% (larger proportionally) |
| Anterior Trunk (Chest + Abdomen) | 18% | 18% |
| Posterior Trunk (Back) | 18% | 18% |
| Each Arm | 9% | 9% |
| Each Leg | 18% | 14% (smaller proportionally) |
| Genitalia | 1% | Not included |
| Total | 100% | 100% |
Understanding the Parkland Burn Formula
Severe burns cause massive fluid shifts from the intravascular compartment into tissues due to increased capillary permeability — a process that begins within minutes of injury and peaks at approximately 8–12 hours. Without prompt intravenous fluid resuscitation, this leads to hypovolemic shock, end-organ failure, and death.
The Parkland equation (often referred to as the Parkland formula for burns), developed by Dr. Charles Baxter in the 1960s, provides a simple, evidence-based starting point for resuscitation in burns covering more than 15% TBSA in adults (or 10% in children).
The Calculation
The standard parkland burn formula is: 4 mL × weight (kg) × %TBSA. This gives the total crystalloid volume needed over 24 hours. Half of this volume is delivered in the first 8 hours from injury, and the second half over the remaining 16 hours. This front-loading reflects the peak capillary leak period in early burn injury.
Fluid Choice
Lactated Ringer's solution (also called Hartmann's solution) is universally preferred over normal saline. Large volumes of 0.9% saline cause hyperchloremic metabolic acidosis, which can complicate the already complex metabolic derangement in burn patients.
Titration — Urine Output is the Target
The Parkland formula calculator provides a starting estimate only. The fluid rate must be dynamically adjusted based on urine output, measured hourly via a catheter:
- Adults: target 0.5 mL/kg/hr
- Children: target 1 mL/kg/hr
- Oliguria → increase fluid rate; excessive output → decrease rate
- Hemoglobinuria (port-wine urine in electrical or chemical burns) → target higher output of 1–2 mL/kg/hr to protect kidneys
Burns Not Requiring Parkland Resuscitation
- Superficial (first-degree) burns — excluded from TBSA entirely
- Burns <15% TBSA in adults — oral rehydration generally sufficient
- Burns <10% TBSA in children — oral rehydration generally sufficient
- Burns to palms, ears, face (first degree only) — no systemic resuscitation needed
Pediatric Considerations
Children require modifications to the standard Rule of Nines due to differing body proportions. The Lund and Browder chart provides the most accurate TBSA estimate for pediatric patients. Additionally, young children often receive maintenance dextrose-containing fluids alongside their Parkland volume to prevent hypoglycemia, which adults do not routinely need.
Frequently Asked Questions
What is the Parkland Formula for burns?
The Parkland equation calculates the volume of intravenous crystalloid fluid required in the first 24 hours after a significant burn injury. The formula is: 4 mL × body weight in kg × percentage TBSA burned. Half the volume is given in the first 8 hours from the time of injury, and the second half over the following 16 hours.
When should I start resuscitation from — injury or arrival?
Always calculate the 8-hour window from the time of injury. If a patient arrives 3 hours after a burn, only 5 hours remain to deliver the first half of the calculated volume. The fluid rate must be increased accordingly to meet the 8-hour deadline from the time of burn, not from ED arrival.
What does TBSA stand for?
TBSA stands for Total Body Surface Area. In burn medicine, %TBSA specifically refers to the percentage of the body surface that has sustained partial-thickness (second-degree) or full-thickness (third-degree) burns. Superficial (first-degree) burns are excluded.
Is the Parkland equation used for chemical and electrical burns?
The parkland formula burns calculation can serve as a baseline for chemical and electrical burns, but these injuries often underestimate their true depth and extent. Electrical injuries cause deep tissue damage not visible at the surface and typically require higher fluid volumes and a higher urine output target (1–2 mL/kg/hr) to protect against myoglobin-induced renal tubular injury.