Calculators › Burn / Critical Care
Lactated Ringer's resuscitation in burn injury. The Parkland formula gives the first 24-hour fluid total — half in the first 8 hours from time of injury, the rest in the next 16. The most common NCLEX trap is forgetting that the clock starts at the burn, not at IV-line placement.
24-hr LR (mL) = 4 mL × weight (kg) × %TBSA
First 8 hr = half the total
Next 16 hr = the other half
The second half is given over twice as long, so the rate halves after the first 8 hours. This catches a lot of new nurses on day 2 of a burn-unit rotation.
Resuscitation timing is anchored to the time of injury, not the time the IV was started. If a patient arrives 3 hours after the burn, you have 5 hours left to deliver the first 50% of the total volume. NCLEX questions love this nuance.
Use the rule-of-nines (head 9, each arm 9, anterior trunk 18, posterior trunk 18, each leg 18, perineum 1) for adults. For children use Lund-Browder because head/leg proportions differ. Superficial (first-degree) burns are not included in the TBSA calculation — only partial- and full-thickness.
Parkland gives a starting estimate. The real titration target is urine output: 0.5 mL/kg/hr in adults, 1 mL/kg/hr in children <30 kg. If urine output is low, increase the rate; if high, taper. Mental status and lactate clearance round out the picture in critical care.
70-kg adult, 40% TBSA partial-thickness burns, presents 1 hour post-injury.
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