Nursing care
Parkland formula in nursing: calculating burn fluids from TBSA to hourly rate
Written and reviewed by Nicole Ramirez, BSN, RN, CMSRN · 4 min read · Updated November 2026
Short answer
The Parkland formula estimates fluid for the first 24 hours after a burn: 4 mL x body weight in kg x percent of total body surface area (TBSA) with partial or full thickness burns. Half is given in the first 8 hours counted from the time of the burn, and the rest over the next 16 hours, adjusted to urine output.
Before the formula: deciding which burns count toward TBSA
MSD Manual is specific that only partial-thickness and full-thickness burns go into the TBSA figure; superficial burns, the red painful skin of a sunburn, are left out. IV resuscitation by formula is generally used when those deeper burns exceed 10 percent TBSA in adults.
| Input | What to use | Common error |
|---|---|---|
| Weight | Kilograms | Using pounds, which inflates the volume 2.2 times |
| %TBSA | Partial and full thickness only, as a whole number | Adding superficial burns, or entering 30 percent as 0.3 |
| Clock start | Time of the burn | Starting the 8 hours at hospital arrival |
| Split | Half in first 8 hours, half over next 16 | Dividing the total evenly over 24 hours |
For adults, the rule of nines divides the body into areas of 9 percent or 18 percent, with each arm about 9 percent. MSD notes that children need a Lund-Browder chart because their heads are proportionally larger and legs smaller, and that for scattered burns the patient's whole open hand is about 1 percent.
Worked example: the patient who arrives two hours late
These are practice figures, not orders. MSD stresses that the 24 hours run from the time of the burn, not from presentation, so a patient who arrives late has less than 8 hours left to receive the first half.
Worked example
- 4 mL x 70 kg x 30 = 8,400 mL in 24 hours
- First half: 8,400 divided by 2 = 4,200 mL due by 2100 (8 hours after the burn)
- Time left in the first window: 2100 minus 1500 = 6 hours
- 4,200 mL divided by 6 hours = 700 mL/hr until 2100
- Second half: 4,200 mL divided by 16 hours = 262.5 mL/hr from 2100
If you had divided 4,200 mL by 8 hours, you would get 525 mL/hr and fall short of the first-half volume by 2100. That is the error exam items are built around. Another one is splitting 8,400 mL evenly across 24 hours at 350 mL/hr, which under-resuscitates exactly when capillary leak is greatest.
Worked example: leaving out the superficial burn
This example tests the TBSA step. Picture a 60 kg adult with partial-thickness burns covering both entire arms and only red, unblistered superficial burns across the face.
Worked example
- Each arm is about 9 percent: 9 + 9 = 18 percent
- Face burns are superficial, so they add 0 percent
- 4 mL x 60 kg x 18 = 4,320 mL in 24 hours
- First 8 hours: 2,160 mL divided by 8 = 270 mL/hr
- Next 16 hours: 2,160 mL divided by 16 = 135 mL/hr
Counting the face as burned area would raise the total and risk overload. MSD warns that too much fluid can lead to heart failure and compartment syndrome, which is why the TBSA estimate needs to be honest rather than generous.
The formula is a starting rate: urine output decides the rest
MSD describes the Parkland number as only a starting point, with rates adjusted to the patient's response. The main bedside measure is urine output: about 0.5 mL/kg/hr in adults and 1.0 mL/kg/hr in children under 30 kg. For the 60 kg patient above, that is roughly 30 mL per hour.
Hourly output below target for two readings, rising heart rate or new confusion point to under-resuscitation. Crackles, increasing edema in unburned areas, tense limbs or a firm, distended abdomen point the other way. MSD recommends lactated Ringer's solution because large volumes of normal saline can cause hyperchloremic acidosis.
Sources and further reading
Burns (MSD Manual Professional Edition). Parkland formula 4 mL/kg x %TBSA; half in first 8 hours from time of burn, rest over 16; only partial and full thickness counted; IV fluids above 10 percent TBSA; rule of nines and Lund-Browder; hand about 1 percent; urine output 0.5 and 1.0 mL/kg/hr; lactated Ringer's; formula as a starting point; fluid overload risks.
Burns (MSD Manual Consumer Version). Rule of nines divides the adult body into sections of 9 or 18 percent; an adult arm is about 9 percent.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our med-surg practice questions are the closest set to what this page covers.
One question from the med-surg set
A client with chronic obstructive pulmonary disease has an oxygen saturation of 88% on 2 L/min via nasal cannula and is alert with no distress. What should the nurse do first?
Rationale
In COPD a saturation of 88–92% is the therapeutic target, not an emergency, and this client is alert with no distress. The first action is the independent nursing intervention that is least invasive and most likely to help: sit them up and reassess. Turning the oxygen up to 6 L/min risks blunting the hypoxic drive, and calling rapid response or drawing an ABG escalates ahead of an assessment you have not finished.
Answer: B
Common questions
How do you calculate the Parkland formula?
Multiply 4 mL by the weight in kilograms and by the percent of TBSA with partial or full thickness burns. That gives the total fluid for the first 24 hours after the burn. Give half in the first 8 hours from the burn time and the other half over the next 16 hours.
How much fluid is given in the first 8 hours?
Half of the 24-hour Parkland total. For a 70 kg adult with 30 percent TBSA, that is 4,200 mL. The 8 hours start at the time of injury, so if the patient arrives late, the same volume is given over the hours remaining in that window.
Does the rule of nines include first-degree burns?
Not for fluid calculations. Superficial burns are excluded from the TBSA used in the Parkland formula; only partial-thickness and full-thickness burns are counted. Including superficial areas overestimates fluid needs.
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