SAQ 409 – Burns – Parkland formula and fluid adjustment

Burns – Parkland formula and fluid adjustment.

a. TBSA estimate

• Rule of nines: right upper limb 9% plus anterior chest wall 9% equals 18%.
• Lund and Browder: right upper limb 8.5% plus anterior chest wall 6.5% equals 15%.
• A range around 15-20% is acceptable if the method is shown.

b. Parkland formula

• Fluid in the first 24 hours in mL = %TBSA x 4 x body weight in kg.

c. Calculation

• Using 18% TBSA and 100 kg: 18 x 100 x 4 = 7200 mL in the first 24 hours.
• Give half in the first 8 hours from the time of burn: 3600 mL, or about 450 mL/hour if starting immediately.
• Give the remaining half over the next 16 hours: 3600 mL, or about 225 mL/hour.
• Use crystalloid such as Hartmann's solution or normal saline.
• Parkland is an initial guide only and must be titrated.

d. Fluid adjustment parameters

• Urine output.
• Heart rate.
• Blood pressure.
• Lactate clearance and renal function.
• CVP or pulmonary arterial pressures if available.
• Complications such as pulmonary oedema, electrolyte disturbance, or cerebral oedema.