First-24-hour burn fluid resuscitation (Baxter & Shires, 1968) — calculate total volume, 8-hour / 16-hour split, mL/hour rate, and urine output target. Adult & child modes.
Check the burned areas (rule of nines, adults):
Check the burned areas:
Selected total: 0% TBSA
Hour 8 is counted from the moment of the burn, not from hospital arrival. If the patient arrives late, the first-half volume must still be completed within the remaining 8-hour window — the phase 1 rate is adjusted accordingly.
Total fluid for the first 24 hours ()
V = 4 × weight (kg) × %TBSA → lactated Ringer volume for the first 24 hours (adults).
V = 3 × kg × %TBSA Ringer laktat ditambah D5RL maintenance fluid via the 4-2-1 rule (4 mL/kg/hour for the first 10 kg, +2 mL/kg/hour for the second 10 kg, +1 mL/kg/hour thereafter).| Body area | %TBSA |
|---|---|
| Head & neck | 9% |
| Tiap lengan | 9% |
| Anterior torso | 18% |
| Posterior torso | 18% |
| Tiap tungkai | 18% |
| Perineum / genitalia | 1% |
| Area | 0–1 thn | 1–4 thn | 5–9 thn | 10–14 thn | 15 thn |
|---|---|---|---|---|---|
| Kepala | 19 | 17 | 13 | 11 | 9 |
| Neck | 2 | 2 | 2 | 2 | 2 |
| Anterior torso | 13 | 13 | 13 | 13 | 13 |
| Posterior torso | 13 | 13 | 13 | 13 | 13 |
| Bokong (per sisi) | 2,5 | 2,5 | 2,5 | 2,5 | 2,5 |
| Genitalia | 1 | 1 | 1 | 1 | 1 |
| Upper arm (per side) | 4 | 4 | 4 | 4 | 4 |
| Lower arm (per side) | 3 | 3 | 3 | 3 | 3 |
| Tangan (per sisi) | 2,5 | 2,5 | 2,5 | 2,5 | 2,5 |
| Thigh (per side) | 5,5 | 6,5 | 8 | 8,5 | 9 |
| Lower leg (per side) | 5 | 5 | 5,5 | 6 | 6,5 |
| Kaki (per sisi) | 3,5 | 3,5 | 3,5 | 3,5 | 3,5 |
Lund–Browder (1944) is more accurate for children because the head proportion shrinks and the leg proportion grows with age. Each column totals 100%.
The Parkland formula (also called the Baxter formula, developed by Charles R. Baxter at Parkland Memorial Hospital, Dallas, in 1968) is the most widely used guide for initial fluid resuscitation in major burns. The formula: total fluid (mL) = 4 × body weight (kg) × %TBSA, given over the first 24 hours. Half the volume is given in the first 8 hours after the burn, the rest over the next 16 hours.
The Parkland formula uses lactated Ringer (also known as Hartmann’s solution) — an isotonic crystalloid whose electrolyte composition resembles plasma. Normal saline is generally avoided for large volumes because of the risk of hyperchloremic acidosis.
Hour 8 is counted from the moment of the burn injury, not from when the patient arrives at the hospital or when the IV is started. Example: if the patient arrives 2 hours after the burn, only 6 hours remain to complete the first-half volume. Counting from arrival time causes under-resuscitation.
Only second-degree (partial thickness) and third-degree (full thickness) burns are included in %TBSA for the Parkland formula. First-degree (superficial, e.g., mild sunburn) does not cause hemodynamically significant fluid shifts, so it is not counted.
In adults, the quick bedside method is the rule of nines (Wallace’s rule of nines): head 9%, each arm 9%, anterior torso 18%, posterior torso 18%, each leg 18%, perineum 1%. In children, use the Lund–Browder chart, which adjusts body proportions by age — more accurate because a child’s head is proportionally larger. This calculator provides an interactive helper for both.
Yes, there is a commonly used pediatric modification: resuscitation with 3 mL × kg × %TBSA (some guidelines use a 3–4 mL range) of lactated Ringer, on the same time schedule (half in 8 hours, the rest in 16 hours), plus concurrent D5RL maintenance fluid — usually via the 4-2-1 rule: 4 mL/kg/hour for the first 10 kg, 2 mL/kg/hour for the second 10 kg, and 1 mL/kg/hour for each kg above 20 kg.
Urine output is the most critical indicator for assessing resuscitation adequacy. The target is 0.5–1 mL/kg/hour in adults and 1–2 mL/kg/hour in children (minimum 1 mL/kg/hour). The fluid rate is raised or lowered based on achieving this target, not rigidly held to the formula’s numbers.
No. The Parkland formula is only a starting point for the calculation. Resuscitation must be titrated against the patient’s response: hourly urine output, pulse, blood pressure, and mental status. Over-resuscitation risks massive edema, compartment syndrome, and ARDS; under-resuscitation risks hypovolemic shock and kidney failure. Conditions such as inhalation injury, electrical burns, or delayed resuscitation generally need more fluid — all clinical decisions.
24-hour total = 4 × 75 × 20 = 6,000 mL of lactated Ringer. Phase 1: 3,000 mL in the first 8 hours → 375 mL/hour. Phase 2: 3,000 mL in the next 16 hours → 188 mL/hour (rounded). Urine output target: 38–75 mL/hour.
This formula is designed for major (extensive) burn resuscitation in the first 24 hours — as a general guide, guidelines often cite thresholds such as above 20% TBSA in adults and above 10% in children, although exact thresholds vary between guidelines. Minor burns are generally managed with oral hydration. The decision to start formal IV resuscitation remains a clinical decision made in a healthcare facility.
Free tool by NRTechStudio
Explore similar health tools and calculators. 100% free, accurate, and runs completely in your browser without sign-up.
2 taps, no typing needed — diagnostics are sent automatically.