Burn & Parkland Calculator
TBSA Estimation (Rule of Nines) & 24-Hour Fluid Resuscitation — Adult & Pediatric
1. Patient Details
2. TBSA — Rule of Nines (Exclude Superficial Burns)
Enter 1 for full area, or decimals for partial involvement (e.g. 0.5 = half the area). Do not include first-degree (superficial) burns.
Rule of Nines — Quick Reference
| 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 Burn Assessment & the Parkland 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 Formula, 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 formula: 4 mL × weight (kg) × %TBSA gives the total crystalloid volume needed over 24 hours. Half 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. Colloids (albumin, fresh frozen plasma) are sometimes added after 8–12 hours in some protocols, but Lactated Ringer's alone is the standard first-line resuscitation fluid.
Titration — Urine Output is the Target
The Parkland calculation is a starting estimate only. Fluid rate must be adjusted based on urine output, measured hourly via catheter:
- Adults: target 0.5 mL/kg/hr
- Children: target 1 mL/kg/hr
- Oliguria → increase 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 resuscitation needed
Pediatric Considerations
Children have proportionally larger head surface areas and smaller legs than adults, so the standard Rule of Nines is modified. The Lund and Browder chart provides the most accurate TBSA estimate for children — particularly neonates and infants — by accounting for age-related body proportion changes. Additionally, children 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?
The Parkland Formula calculates the volume of intravenous crystalloid fluid required in the first 24 hours after a significant burn injury: 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 count 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 rate should 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 formula used for chemical and electrical burns?
The Parkland Formula can serve as a baseline for chemical and electrical burns, but these injuries often underestimate their true depth and extent, and electrical injuries cause deep tissue damage not visible at the surface. Electrical burns typically require higher fluid volumes and a urine output target of 1–2 mL/kg/hr to protect against myoglobin-induced renal tubular injury.