The Parkland Formula (also known as the Baxter formula) is a widely used method in emergency medicine and burn care. It estimates the volume of fluid required to resuscitate a patient in the first 24 hours following a severe burn injury.
The Principle of Burn Resuscitation
Severe burns cause significant damage to the skin and underlying capillaries. This damage leads to a massive shift of fluids and proteins out of the blood vessels into the surrounding tissues, causing profound edema and risking hypovolemic shock (burn shock). Rapid, calculated intravenous fluid resuscitation is critical to maintain blood pressure and organ perfusion.
The Formula
The Parkland formula calculates the total volume of Lactated Ringer's (LR) solution needed in the first 24 hours after the time of injury.
Administration Strategy
The total calculated volume is not given all at once. It is divided to reflect the rapid fluid loss in the early hours after the burn:
- First 8 hours: Give 50% of the total calculated volume.
- Next 16 hours: Give the remaining 50% of the total volume.
Important: The clock starts at the exact time of the burn injury, not the time the patient arrives at the hospital.
Calculating TBSA (The Rule of Nines)
To use the formula, you must accurately estimate the Total Body Surface Area (TBSA) affected. The Rule of Nines is commonly used for adults:
- Head and neck: 9%
- Anterior trunk: 18%
- Posterior trunk: 18%
- Each arm: 9% (Total 18%)
- Each leg: 18% (Total 36%)
- Perineum/Genitalia: 1%
Note: Only partial-thickness (second-degree) and full-thickness (third-degree) burns are included in the TBSA. Superficial (first-degree) burns like sunburns are excluded.
Clinical Examples
Example: Standard Resuscitation
Profile: A 70 kg adult male suffers burns to his entire anterior trunk (18%) and both entire arms (18%).
- TBSA: 18% + 18% = 36%
- Total Fluid (24 hrs): 4 mL × 70 kg × 36 = 10,080 mL
- First 8 hours: 5,040 mL (Rate: 630 mL/hr)
- Next 16 hours: 5,040 mL (Rate: 315 mL/hr)
Monitoring and Titration
The Parkland Formula is just a starting point. Clinicians must titrate the fluid rate based on the patient's physiological response. The most reliable non-invasive marker for adequate organ perfusion is urine output (UOP).
- Adult Target UOP: 0.5 to 1.0 mL/kg/hr (roughly 30-50 mL/hr)
- Pediatric Target UOP: 1.0 to 1.5 mL/kg/hr
If urine output is lower than the target, increase the fluid rate. If it is higher, decrease the fluid rate to avoid fluid overload, which can lead to compartment syndrome or pulmonary edema.
References
- Baxter CR. Fluid volume and electrolyte changes of the early postburn period. Clin Plast Surg. 1974;1(4):693-703.
- Advanced Trauma Life Support (ATLS). American College of Surgeons.