What is the Parkland formula and how is it applied for burn fluid resuscitation?

• A. 4 mL × body weight (kg) × %TBSA burned in the first 24 hours; half given in the first 8 hours from time of burn and the rest over the next 16 hours, with adjustments based on urine output and hemodynamics.
• B. 2 mL × body weight × %TBSA burned over 48 hours.
• C. 10 mL × weight × age.
• D. Fluid resuscitation is not required for burns.

Answer: (A)

Fluid resuscitation after a significant burn is about restoring circulating volume as the body’s capillaries leak fluid. The Parkland formula provides a practical way to estimate how much crystalloid is needed in the first 24 hours. It uses lactated Ringer’s solution and prescribes a total amount equal to 4 mL per kilogram of body weight per percent of burn area (TBSA). Half of that total is given in the first 8 hours from the time of burn, and the remaining half over the next 16 hours. Time since injury matters, so if you arrive later, you base the schedule on how long ago the burn occurred. You don’t just send a fixed amount; you titrate based on how the patient is perfusing, using urine output and hemodynamic status as guides. A common target in adults is about 0.5 mL/kg/hour of urine output, adjusting fluid rate to avoid under-resuscitation or over-resuscitation.

For example, a 70 kg patient with 40% TBSA burned would need about 11,200 mL in the first 24 hours (4 × 70 × 40). Split, that’s 5,600 mL in the first 8 hours and 5,600 mL over the next 16 hours.

This approach aligns with the option describing the 4 mL × kg × %TBSA calculation, the 50% in the first 8 hours and 50% in the following 16 hours, with adjustments based on urine output and hemodynamics. Other formulations or statements that use different multipliers, longer time frames, or deny fluid resuscitation don’t reflect the standard burn resuscitation practice.