Anaes · Plastics and burns anaesthesia
Burn resuscitation: Parkland formula, endpoints, and fluid creep
Also known as Burn resuscitation: Parkland formula, endpoints, and fluid creep · Baxter formula burns
Exam-exhaustive Parkland burn resuscitation for ANZCA Final: exact 4 mL × kg × percent TBSA timing from injury, urine output endpoints, fluid creep, rule of nines, modern low-start practice, and linkage to airway and suxamethonium restrictions.
Checked against its sources on 13 Sept 2026
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Red flags
- Clock starts at injury not arrival.
- 4 mL × kg × %TBSA Hartmann/LR.
- Half in 8 h; half in 16 h.
- Adult UO ~30-35 mL/h; modern start 2 mL.
- Default suxamethonium to banned in burns.
Meet the patient
A 90 kg man is extricated from a petrol fire at noon with partial and full-thickness burns later mapped at 45 percent TBSA. Prehospital crews give oxygen and 1.5 L of crystalloid. He arrives at 13:30 — ninety minutes after injury. The clock for his first eight-hour window started at noon, not at arrival, and the formula is only the starting rate.[6]
The two sentences that earn the marks: Parkland is 4 mL per kilo per percent TBSA of Hartmann, half in eight hours from injury, and I titrate to urine output — the formula is a starting rate, not a prescription. Speak both without hesitation.[6][5]
References10ShowHide
- [1]Baxter CR Fluid volume and electrolyte changes of the early postburn period Clin Plast Surg, 1974.PMID 4609676
- [2]Martyn JA, Richtsfeld M Succinylcholine-induced hyperkalemia in acquired pathologic states: etiologic factors and molecular mechanisms. Anesthesiology, 2006.PMID 16394702
- [3]Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet, 2010.PMID 20554319
- [4]Roberts I, Shakur H, Afolabi A, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet, 2011.PMID 21439633
- [5]Mehta M, Tudor GJ Parkland Formula StatPearls, 2026.PMID 30725875
- [6]Saffle JI The phenomenon of fluid creep in acute burn resuscitation. J Burn Care Res, 2007.PMID 17438489
- [7]Cartotto R, Johnson LS, Savetamal A, et al. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. J Burn Care Res, 2024.PMID 38051821
- [8]Moore RA, Popowicz P, Burns B Rule of Nines. StatPearls, 2024.PMID 30020659
- [9]Sánchez-Sánchez M, García-de-Lorenzo A, Asensio MJ First resuscitation of critical burn patients: progresses and problems. Med Intensiva, 2016.PMID 26873418
- [10]Gronert GA, Theye RA Pathophysiology of hyperkalemia induced by succinylcholine. Anesthesiology, 1975.PMID 1147311