Pediatric Anesthesia 2010 20: 305–312 doi:10.1111/j.1460-9592.2010.03273.

An allometric model to estimate fluid requirements

in children following burn injury
J . M A R K A N S E R M I N O M B B C h F R C P C , F F A ( S A ) , C H R IS T IN E
A . V A N D E B EE K M B A A N D D O R O TH Y M Y E R S M S c
Department of Anesthesiology, British Columbia’s Children’s Hospital and University of British
Columbia, Vancouver, BC, Canada

Section Editor: Prof. Brian Anderson

Summary
Objectives: To evaluate the ability of an allometric 3 ⁄ 4 Power Model
combined with the Galveston Formula (Galveston-3 ⁄ 4 PM Formula) to
predict fluid resuscitation requirements in children suffering burn
injuries in comparison with the frequently used Parkland Formula
and Galveston Formula using the Du Bois formula for surface area
estimation (Galveston–DB Formula).
Aim: To demonstrate that the Galveston-3 ⁄ 4 PM Formula is clinically
equivalent to the Galveston–DB Formula for the estimation of fluid
requirements in pediatric burn injury cases.
Background: Fluid resuscitation requirements differ in children
suffering burn injuries when compared to adults. The Parkland
Formula works well for normal weight adults but underestimates
fluid requirements when indiscriminately applied to pediatric burn
patients. The Galveston–DB Formula accounts for the change in body
composition with age by using a body surface area (BSA) model but
requires the measurement of height. The allometric model, using an
exponent of 3 ⁄ 4, accounts for the dependence of a physiological
variable on body mass without requiring height measurement and
can be applied to estimate fluid requirements after burn injury in
children.
Methods: Comparisons were performed between the hourly calculated
fluid requirements for the first 8 h following 20%, 40%, and 60% BSA
burns using the Parkland Formula, the Galveston–DB Formula and
Galveston-3 ⁄ 4 PM Formula for children 2–23 kg.
Results: In children less than 23 kg, the fluid requirements predicted
by the Galveston-3 ⁄ 4 PM Formula are well correlated with those
predicted by the Galveston–DB Formula (R2 = 0.997, P < 0.0001) and
are much better than of the predictions made with the Parkland
Formula, especially for children <10 kg.
Conclusions: For the purposes of clinical estimation of fluid require-
ments, the Galveston-3 ⁄ 4 PM Formula is indistinguishable from the
Galveston–DB Formula in children 23 kg or less.

Correspondence to: J. Mark Ansermino, Assistant Professor, University of British Columbia, British Columbia’s Children’s Hospital, 4480 Oak
Street, Room 1L7, Vancouver, BC, Canada V6H 3V4 (email: anserminos@yahoo.ca).

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306 J. M . A N S E R M I N O E T A L .
Keywords: fluid requirements; burn injuries; anesthesia, pediatric;
allometric 3 ⁄ 4 Power model; Parkland formula, Galveston formula
Introduction
In the immediate postburn period, alterations in
vascular permeability and the imbalance of osmotic
forces cause significant fluid and protein losses.
Moyer et al. (1) proved the contribution of the Na+
ion in the intracellular and extracellular distribution
of electrolytes and water during the initial period of
burn resuscitation and advocated the early use of
balanced salt solutions. Fluid resuscitation within
the first 24 h following burn injury is critical for
pediatric patients whose burns are estimated to
cover more than 10% of their total body surface area
(BSA). In these cases, the goal is the maintenance of
vital organ function at the lowest immediate or
delayed physiological cost. Too little fluid can cause
hypoperfusion, while too much fluid may lead to
edema, which will cause tissue hypoxia.
Clinicians rely on a handful of commonly known
formulae to estimate the amount of fluid required,
where the inputs are the weight of the patient and
the estimated percentage of BSA that is burned.
These fluid resuscitation calculations must be made
rapidly and accurately, but it is well known that
these formulae serve only as guidelines to fluid
replacement therapy. Evaluation of the clinical
condition of the patient and monitoring of clinical
parameters, such as urine output, are important
guides to adequate resuscitation. However, the
formulae do provide a starting point for fluid
administration in the first few hours followed by
adjustments based on the clinical response to fluid
resuscitation. Formulae-based guidelines are partic-
ularly helpful for clinicians who do not routinely
deal with burn injuries or when expert burn advice
is not immediately available.
The Parkland formula
The Parkland Resuscitation Formula was introduced
by Baxter in 1974 (2). Safe and easy to calculate, the
Parkland Formula is the most commonly applied
guideline for initial fluid resuscitation worldwide
(3). The calculation takes into account total BSA burn
and patient weight to give an appropriate fluid
administration rate:
4 ml  weight (kg)  % BSA burn
¼ volume (ml) of Lactated Ringer0 s for first 24 h
The Parkland Formula can work well for the
average adult patient when the burn size is well
estimated; however, this formula can potentially
overestimate fluid requirements in the obese subject.
It can also grossly underestimate fluid requirements
when indiscriminately applied to pediatric burn
patients (4). Pediatric patients (especially those < 20
kg) have a significantly different body composition
with a larger surface area and extracellular volume
(5) relative to weight compared to adult patients.
The Galveston formula
An alternative formula to calculate fluid needs for
children is the Galveston Formula, which is based on
BSA rather than weight. The BSA model, first
proposed by Du Bois and Du Bois (6), has been
widely used as a more accurate alternative to the per
kg model for scaling drug doses for children out of
infancy. Body surface area is calculated from height
and weight:
BSA ¼ weightðkgÞ0:425  height (cm) 0:725  0:007184
In 1980, Carvajal (7) advocated that this formula
for estimating BSA should be part of a safe, accurate,
and effective fluid resuscitation program for patients
of all ages (4). This model accounts for the change in
body morphology with age also but requires the
additional measurement of height.
The BSA model is better than estimating fluid
requirements based on weight alone and is conse-
quently widely used in pediatric burn centers. How-
ever, the Galveston Formula, where BSA is calculated
by the Du Bois formula (Galveston–DB Formula), is
complicated by requiring a measurement of height,
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 A L LO M E T R I C M O D EL F O R P E D I A TR I C PO S T BU R N F L U I D S
which is fraught with inaccuracies when performed
in the acute care setting. More often than not, the
patient is in a position such that clinicians must
provide an estimate, often inaccurate, of the head to
toe height. Furthermore, the surface area model
assumes that the relationship between surface area
and fluid distribution in adults and children is
similar. This assumption does not fit observations
(8). Infants have short stumpy legs with large trunks
and heads. In a similar way, obese adults do not
have the same geometric proportions as nonobese
adults.
3 ⁄ 4 allometric scaling
Allometric growth is unequal growth in one part of
an organism relative to growth of the whole organ-
ism. Size affects rates of all biological structures and
processes from cellular metabolism to population
dynamics. The dependence of a biological variable,
Y, on body mass, M, is typically characterized by the
allometric scaling law:
Y ¼ kMðPWRÞ
The value of PWR has been the subject of much
debate (9,10). The most common variable investi-
gated is the basal metabolic rate (BMR), with some
advocating a PWR value of 2 ⁄ 3 and others advocat-
ing a value of 3 ⁄ 4. BSA can be estimated using a
PWR value of 2 ⁄ 3, and Sarrus and Rameaux (11) put
forward the empirical theory that the rate of heat
production of large and small animals is in propor-
tion to their respective surface areas. In 1932, Keibler
(12) established that in all species, including
humans, the log of the BMR plotted against the log
of body weight produces a straight line with a slope
(PWR) of 3 ⁄ 4. Explanations for this phenomenon
vary, but this exponential function is the same for
Table 1
Formulae for calculating hourly fluid requirements
Estimated replacement volume in 1 h
Parkland formula
Galveston–DB (Du Bois) formula
Galveston-3 ⁄ 4 PM (3 ⁄ 4 Power Model) formula
Estimated maintenance volume in 1 h
Parkland formula
Galveston–DB (Du Bois) formula
Galveston-34 PM (3 ⁄ 4 Power Model) formula
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3 07
homeotherms, poikilotherms, and unicellular organ-
isms (8).
Allometric modeling may be used to scale main-
tenance drug doses, drug clearances (PWR = 3 ⁄ 4),
blood volume, vital capacity, and tidal volume in
children (PWR = 1) (13). The BSA model originally
developed by Du Bois is believed to reflect extracel-
lular fluid (ECF) volume (14). However, a nonlinear
model using an allometric exponent of 3 ⁄ 4 on
weight, which was not considered in the original
study by Friis-Hansen (14), has been shown to have
an improved fit compared to the original data. A
Galveston Formula using a BSA based on an allo-
metric 3 ⁄ 4 power scale (Galveston-3 ⁄ 4 PM Formula)
would appear, therefore, to offer the opportunity to
develop a universal formula for estimation of fluid
requirements after burn injury.
Methods
To calculate the BSA for the Galveston–DB Formula,
the average weight for length tables from the Centre
for Disease Control and Prevention (CDC) were
used to construct a table of average weights and
heights of male and female children from 2 to 23 kg
at half-kilogram intervals (15). The intervals and
weights were determined by the data in a standard
CDC chart.
Comparisons were performed between the calcu-
lated fluid requirements per hour for the first 8 h
following 20%, 40%, and 60% BSA burns using the
Parkland Formula, the Galveston–DB Formula, and
the Galveston-3 ⁄ 4 PM Formula for children 2–23 kg.
Pearson’s correlation coefficient was used to mea-
sure correlation. The formulae are shown in Table 1.
In estimating the BSA using the 3 ⁄ 4 allometric scale
for the Galveston-3 ⁄ 4 PM Formula, we employed a
standard weight of 75 kg and a BSA of 2 m2, values
that represent the average adult model:
weightðgÞ  % area burned  14
2
5000 ðmlÞ  % area burned  BSA ðDuBoisÞ
h ðm Þ  16i3=4
weight ðkgÞ
5000 ðmlÞ  % area burned  adult BSA ðm2 Þ  adult weight ðkgÞ 16
None
2
2000 ðmLÞ  BSA ðDuBoisÞ
h ðm Þ  16i3=4
weight ðkgÞ
2000 ðmlÞ  adult BSA ðm2 Þ  adult weight ðkgÞ 16
308 J. M . A N S E R M I N O E T A L .

BSA (m2 Þ ¼ adult BSA (m2 Þ The fluid requirements predicted by the Galves-
 ð3=4Þ ton-3 ⁄ 4 PM Formula are well correlated with those
weight (kg)
 predicted by the Galveston–DB Formula (R2 = 0.997,
adult weight (kg) P < 0.0001) (Figures 2a, 3a, and 4a). Compared with
 
weight (kg) ð3=4Þ both the Galveston–DB Formula and Galveston-3 ⁄ 4
¼2 
75 PM Formula, the data show that the Parkland
Formula grossly underestimates fluid requirements
in children with smaller burns and overestimates
Results
requirements as the burn size increases. In addition,
For the purposes of clinical estimation of BSA in in patients weighing 12 kg and under, the Parkland
children <23 kg, the 3 ⁄ 4 allometric scale is indistin- Formula displays a significant percentage of differ-
guishable from the Du Bois Formula (Figure 1a,b). ence compared with the Galveston–DB Formula

(a)

(b)

Figure 1
(a) Comparison of body surface
area (BSA) calculated by the Du
Bois Formula and the 3 ⁄ 4 Power
Model. (b) Percent difference
between the BSA calculated by
the Du Bois Formula in compar-
ison with the 3 ⁄ 4 Power Model.

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 A L LO M E T R I C M O D EL F O R P E D I A TR I C PO S T BU R N F L U I D S 3 09

(a)

(b)

Figure 2
(a) Comparison of the Parkland
Formula, the Galveston–DB
Formula, and the Galveston-3 ⁄ 4
PM Formula for male children
with 20% body surface area
(BSA) burn. (b) Percent difference
between the volume of fluid per
hour (ml) generated by the
Parkland Formula and the
Galveston–3 ⁄ 4 PM Formula in
comparison with the Galveston–
DB Formula for male children
with 20% BSA burn.

(Figures 2b, 3b, and 4b). The predictions of the
Galveston-3 ⁄ 4 PM Formula are much closer to the
predictions based on the Galveston–DB Formula
than the Parkland Formula. The percent difference
between the Galveston-3 ⁄ 4 PM Formula and the
Galveston–DB Formula predictions remains constant
for each weight calculated across the three percent-
ages (20%, 40%, and 60%) of BSA burns investi-
gated (Figures 2b, 3b, and 4b).
Discussion
A 3 ⁄ 4 allometric scaling of body weight provides
an accurate estimate of BSA. When used in the
Galveston Formula (Galveston-3 ⁄ 4 PM Formula),
predicted hourly fluid requirements are comparable
to models based on the estimation of BSA or fluid
requirements from height and weight, such as the
Galveston–DB Formula. There appears to be no
added benefit from including an additional variable,
height, into the calculation. Body surface area has
previously been calculated using the Boyd Formula,
which also omits height in its calculation. The Boyd
Formula (16) uses weight as an independent variable
(17), but its complexity prohibits routine use:
 
BSA cm2 ¼ 4:688  W 0:81680:0154logðW Þ
where W is the body weight in g.

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310 J. M . A N S E R M I N O E T A L .
(a)
(b)
The common problem of underestimating burn
resuscitation volumes in smaller children when
using the Parkland Formula, as shown by Carvajal
in 1994, can be avoided with the use of an allometric
scale (4). This is demonstrated when fluid volumes
are predicted by the Galveston-3 ⁄ 4 PM Formula,
which does not underestimate fluid requirements in
small BSA burns nor overestimate fluid require-
ments in larger BSA burns as found with the
Parkland Formula (Figures 2a, 3a, and 4a). The
Galveston-3 ⁄ 4 PM Formula, unlike the Parkland
Formula, is not an easy calculation that can be
handwritten on the medical record of the burn
patient. However, even with a calculation as simple
Figure 3
(a) Comparison of the Parkland
Formula, the Galveston–DB
Formula, and the Galveston-3 ⁄ 4
PM Formula for male children
with 40% body surface area
(BSA) burn. (b) Percent difference
between the volume of fluid per
hour (ml) generated by the
Parkland Formula and the
Galveston-3 ⁄ 4 PM Formula in
comparison with the Galveston–
DB Formula for male children
with 40% BSA burn.
as the Parkland Formula, mathematical errors can
occur. Steady progress toward decision support
systems in the clinical environment has made it
increasingly possible to apply more complex math-
ematical formulae to every day clinical problems. In
addition, the ready availability of personal digital
assistants would enable emergency physicians to use
the Galveston-3 ⁄ 4 PM Formula to predict fluid
requirements for all burn patients, based on weight
alone, regardless of height.
When defining an allometric 3 ⁄ 4 scale model, the
ideal characteristics (a standard height and weight)
must be defined. We used 75 kg and 2 m2 and did
not correct for sex. A change in these values will
 2010 Blackwell Publishing Ltd, Pediatric Anesthesia, 20, 305–312
 A L LO M E T R I C M O D EL F O R P E D I A TR I C PO S T BU R N F L U I D S 3 11

(a)

(b)

Figure 4
(a) Comparison of the Parkland
Formula, the Galveston–DB
Formula, and the Galveston-3 ⁄ 4
PM Formula for male children
with 60% body surface area
(BSA) burn. (b) Percent difference
between the volume of fluid per
hour (ml) generated by the Park-
land Formula and the Galveston-
3 ⁄ 4 PM Formula in comparison
with the Galveston–DB Formula
for male children with 60% BSA
burn.

make a small change in the calculation but should
not be of substantive clinical relevance. The differ-
ence in volume calculation between subjects is likely
to be much larger than the differences introduced by
changes in the ideal characteristics.
The Galveston-3 ⁄ 4 PM Formula still attempts to
estimate BSA before applying a calculation identical
to that employed when the BSA is estimated from
height and weight. This allometric scaling of body
proportions provides an accurate estimate of BSA
(Figure 1a,b) and consequently fluid requirements
following burn injury (Figures 2a, 3a, and 4a). We
suggest this as an alternative to the Galveston–DB
Formula in computerized systems, avoiding the
increased risk of error through the need to measure
height.
Allometric scaling could also find application in a
number of other areas of burn care. This could
include the calculation of energy requirements,
calculation of drug doses, and estimation of fluid
losses during surgery. Although the Galveston–3 ⁄ 4
PM Formula compares well with the Galveston–DB
Formula across BSA burn sizes (Figures 2b, 3b, and
4b), its ability to improve patient outcome has not
been tested. The true test of any regime would be to
demonstrate a superior degree of resuscitation and

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312 J. M . A N S E R M I N O E T A L .
improved survival. We have not attempted to do this
but feel these theoretical findings provide sound
guidelines for testing in a randomized controlled
trial. We also acknowledge that fluid resuscitation
calculations are a starting point for fluid adminis-
tration in the first few hours and successful fluid
management in pediatric burn injuries requires close
clinical evaluation of the patient. The method pre-
sented in this article has been compared with
currently used methods in a theoretical standardized
patient, and the results should be interpreted with
caution for this reason.
Acknowledgements
The authors would like to thank Brian Anderson and
the reviewers for the careful review and suggestions
included in this manuscript.
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