Parkland Burn Formula

Michael Sow

2 min read

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29-11-2024

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The Parkland Burn Formula is a cornerstone of burn management, providing a guideline for fluid resuscitation in patients suffering from significant burns. However, it's crucial to understand its limitations and the evolving landscape of burn care. This formula, while widely used, isn't a one-size-fits-all solution and requires careful clinical judgment alongside its application.

Understanding the Formula

The Parkland formula calculates the total fluid requirement over the first 24 hours post-burn. It's based on the patient's body surface area (BSA) affected by the burn and their body weight. The formula is:

4 mL x TBSA (%) x weight (kg) = Total fluid requirement (mL) in 24 hours

• 4 mL: This represents the amount of lactated Ringer's solution (LRS) administered per kilogram of body weight and percentage of total body surface area (TBSA) burned.
• TBSA (%): The percentage of the body surface area affected by second- and third-degree burns. This is often estimated using the "rule of nines" or a specialized burn diagram.
• Weight (kg): The patient's weight in kilograms.

Administering the Fluids

The calculated total fluid requirement isn't administered all at once. Instead, it's given in two halves:

• First half: Administered over the first eight hours post-burn.
• Second half: Administered over the remaining 16 hours.

This staggered approach aims to maintain adequate hydration while minimizing the risk of fluid overload.

Limitations and Considerations

While the Parkland formula offers a valuable starting point, it's essential to recognize its limitations:

• Individual Variation: The formula provides an estimate, and individual responses to burn injury vary significantly. Factors such as age, pre-existing conditions, and inhalation injuries can significantly affect fluid requirements.
• Burn Depth and Location: The formula primarily focuses on second- and third-degree burns. Superficial burns often require less aggressive fluid resuscitation. The location of the burn can also influence fluid needs.
• Ongoing Assessment: Continuous monitoring of vital signs, urine output, and hemodynamic parameters is crucial. Adjustments to the fluid regimen may be necessary based on the patient's response.
• Not a Substitute for Clinical Judgment: The Parkland formula is a guide, not a rigid protocol. Experienced clinicians must interpret the formula's results in light of the patient's specific circumstances.

Modern Approaches

Modern burn care incorporates more sophisticated techniques beyond the Parkland formula. These include:

• Early Goal-Directed Therapy: This approach focuses on achieving specific physiological targets, such as maintaining adequate urine output and central venous pressure, rather than strictly adhering to a pre-calculated fluid volume.
• Individualized Fluid Management: This emphasizes tailoring fluid resuscitation to the individual patient's response, based on continuous monitoring and assessment.

Conclusion

The Parkland Burn Formula remains a valuable tool in the initial management of severe burns. However, it should be used judiciously, acknowledging its limitations and integrating it into a broader strategy of continuous monitoring and individualized care. The ultimate goal is to optimize fluid resuscitation while minimizing the risks of both under-resuscitation and fluid overload, leading to the best possible patient outcomes. Advances in burn care emphasize a shift towards more dynamic and personalized approaches beyond a solely formula-based approach.