## Parkland Formula for Burn Fluid Resuscitation **Key Point:** The Parkland formula is the gold standard for calculating initial fluid requirements in moderate-to-severe burns (>20% TBSA). It is based on crystalloid (Ringer's lactate) administration. ### Parkland Formula $$\text{Total 24-hour fluid (mL)} = 4 \times \text{Body weight (kg)} \times \text{TBSA (\%)}$$ **High-Yield:** - **Half of the calculated volume** is given in the **first 8 hours** from the time of injury. - **Remaining half** is given over the **next 16 hours**. - The goal is to maintain **urine output**: 0.5 mL/kg/hr for adults, 1 mL/kg/hr for children and electrical burns. ### Clinical Application **Example:** 70 kg man with 40% TBSA burn - Total 24-hr fluid = 4 × 70 × 40 = **11,200 mL** - First 8 hours: 5,600 mL (700 mL/hr) - Next 16 hours: 5,600 mL (350 mL/hr) - Adjust rate based on urine output (target: 0.5 mL/kg/hr) **Clinical Pearl:** The Parkland formula is a **starting point**, not a fixed protocol. Titrate fluids to urine output, not just the formula. Over-resuscitation ("fluid creep") leads to compartment syndrome, ARDS, and increased mortality. **Warning:** Do not use Parkland for burns <20% TBSA — maintenance fluids + oral rehydration are sufficient. Do not use for inhalation injury assessment alone — adjust upward if present. ### Why Ringer's Lactate? - Contains K^+^ and Ca^2+^ — better physiologic composition than normal saline. - Reduces hyperchloremic acidosis. - Normal saline alone increases risk of acute kidney injury. 
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