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Parkland Burn Formula

Lactated Ringer's resuscitation in burn injury. The Parkland formula gives the first 24-hour fluid total, half in the first 8 hours from time of injury, the rest in the next 16. The most common NCLEX trap is forgetting that the clock starts at the burn, not at IV-line placement.

Use rule-of-nines or Lund-Browder. Count partial- and full-thickness only, superficial burns don't count.

The 8-hour clock starts at the time of injury, not arrival. If 2 hours have already passed, you have 6 hours left to deliver the first half.

24-hour LR total
, mL
Enter weight and TBSA to calculate.

The formula

24-hr LR (mL)  =  4 mL  ×  weight (kg)  ×  %TBSA
First 8 hr     =  half the total
Next 16 hr     =  the other half

The second half is given over twice as long, so the rate halves after the first 8 hours. This catches a lot of new nurses on day 2 of a burn-unit rotation.

The 8-hour clock starts at the burn

Resuscitation timing is anchored to the time of injury, not the time the IV was started. If a patient arrives 3 hours after the burn, you have 5 hours left to deliver the first 50% of the total volume. NCLEX questions love this nuance.

NCLEX trap: A 70-kg adult with 50% TBSA burns gets 14,000 mL of LR in 24 hours, 7,000 mL in the first 8, 7,000 in the next 16. If the question says "presents 2 hours post-burn," the first 7,000 mL must finish in 6 hours, not 8, that's a rate of about 1,167 mL/hr, not 875.

What counts as TBSA

Use the rule-of-nines (head 9, each arm 9, anterior trunk 18, posterior trunk 18, each leg 18, perineum 1) for adults. For children use Lund-Browder because head/leg proportions differ. Superficial (first-degree) burns are not included in the TBSA calculation, only partial- and full-thickness.

Endpoints, when am I giving enough?

Parkland gives a starting estimate. The real titration target is urine output: 0.5 mL/kg/hr in adults, 1 mL/kg/hr in children <30 kg. If urine output is low, increase the rate; if high, taper. Mental status and lactate clearance round out the picture in critical care.

Worked example

70-kg adult, 40% TBSA partial-thickness burns, presents 1 hour post-injury.

  1. Total: 4 × 70 × 40 = 11,200 mL LR over 24 hr.
  2. First 8 hr: 5,600 mL, but you have 7 hours left, so 5,600 ÷ 7 = ~800 mL/hr.
  3. Next 16 hr: 5,600 mL ÷ 16 = 350 mL/hr.
IV Drip Rate CalculatorSet the LR rate at the bedside. MAP CalculatorHemodynamic target for organ perfusion in shock states. Lab Values Cheat SheetCritical thresholds for the NCLEX, including burn-relevant labs.

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