Parkland Formula Calculator

TBSA (total body surface area burned) in the Parkland formula counts only partial-thickness (2nd degree) and full-thickness (3rd degree) burns. Superficial (1st degree) burns like sunburn are explicitly excluded, even though they are red and painful, because they do not produce the capillary leak and plasma loss that drives Parkland's volume estimate. Including 1st degree burns is one of the most common errors and leads to dangerous over-resuscitation, abdominal compartment syndrome, and pulmonary edema. If a burn blanches without blistering and lacks any blistered or charred areas, it does not count. When in doubt, undercall TBSA and titrate up to urine output rather than padding the number.

The adult Rule of Nines assigns 9 percent to the head, 9 percent to each arm, 18 percent to each leg, 18 percent to the anterior trunk, 18 percent to the posterior trunk, and 1 percent to the perineum. For irregular or patchy burns the patient's own palm (palmar surface plus fingers) approximates 1 percent TBSA. The Rule of Nines is inaccurate in children because their head is proportionally larger (about 18 percent in an infant, falling to 9 percent by age 9) and legs are smaller; use the Lund-Browder chart for pediatric and infant burns to avoid overestimating the head and underestimating the legs. Burn centers re-measure TBSA on arrival because field estimates are typically off by 5 to 15 percent, which is why titration to urine output ultimately matters more than the initial number.

Lactated Ringer's (LR) is the ABA, ATLS, and Surviving Sepsis preferred crystalloid for burn resuscitation for two reasons. First, the chloride load: 0.9 percent saline contains 154 mmol/L of chloride versus plasma's 100 to 110 mmol/L, and the volumes given in the first 24 hours of a major burn (often 6 to 12 liters in an adult) cause a predictable hyperchloremic metabolic acidosis that worsens burn-induced acidosis and renal injury. Second, the lactate in LR (28 mmol/L) is metabolized by the liver into bicarbonate within minutes in a perfused patient, which actively buffers the metabolic acidosis from tissue hypoperfusion and the burn itself. LR's electrolyte profile (sodium 130, potassium 4, calcium 1.5) is closer to plasma than NS. NS is reserved for niche cases (some early DKA, TBI where lactate confuses cerebral metabolism, or LR contraindications like simultaneous ceftriaxone infusion).

Pediatric patients require both Parkland resuscitation fluid AND a separate maintenance infusion, while adults receive only Parkland in the first 24 hours. Children have a higher surface-area-to-mass ratio (greater insensible losses), smaller glycogen stores (risk of hypoglycemia if NPO), and immature renal concentrating ability, so they cannot maintain basic metabolic needs from the resuscitation fluid alone. Maintenance is calculated by the Holliday-Segar 4/2/1 rule: 4 ml/kg/hour for the first 10 kg, plus 2 ml/kg/hour for the next 10 kg, plus 1 ml/kg/hour for each kg above 20. A 25 kg child needs (10 x 4) + (10 x 2) + (5 x 1) = 65 ml/hour of maintenance D5LR or D5 1/2 NS, running concurrently with the Parkland LR. Forgetting maintenance fluid in pediatric burns is a common error that leads to hypoglycemia, hypernatremia, and inadequate resuscitation despite a correctly calculated Parkland number.

The American Burn Association's referral criteria require transfer to a verified burn center for any of the following: partial-thickness burns over 10 percent TBSA, any 3rd degree burn at any size, burns to the face, hands, feet, genitalia, perineum, or over major joints (functional and cosmetic risk), electrical burns including lightning (deep tissue injury and arrhythmia risk that the surface appearance hides), chemical burns (ongoing tissue damage and systemic toxicity), inhalation injury (suspect with facial burns, singed nasal hair, carbonaceous sputum, hoarseness, stridor, or closed-space exposure), burns with comorbid disease that complicates management (diabetes, immunocompromise, end-stage renal or liver disease), concomitant trauma where the burn is the greater risk, and any pediatric burn at a hospital without pediatric burn expertise. The 20 percent adult and 10 percent pediatric TBSA thresholds also trigger ICU-level monitoring. When in doubt, call the regional burn center early; transfer is easier in the first 24 hours before the patient becomes too volume-overloaded or unstable to fly.