Revisiting The Baxter-Parkland Rescucitation Formula for Optimal Fluid Therapy in Haemodynamic Resuscitation for Burn Case in Resource-Limited Settings

Background: Fluid resuscitation plays a crucial role in managing severe burn injuries, particularly in patients with burns covering more than 20% of their total body surface area (TBSA). The Baxter-Parkland formula remains the globally accepted standard for calculating fluid resuscitation, yet variations in its application have led to confusion, particularly in resource-limited settings. Case Presentation: We present a case of a 28-year-old female who sustained second- and third-degree burns covering 52.5% of her TBSA following a gas explosion. Upon admission to the emergency department, she received fluid resuscitation based on the modified Baxter-Parkland formula at a rate of 2 mL/kg/%TBSA, with half of the calculated volume administered in the first 8 hours. Clinical assessments included airway management, oxygen supplementation, and burn wound care using silver sulfadiazine and wound dressing. Pain management and stress ulcer prophylaxis were initiated. Within the first hour, the patient demonstrated an adequate urine output indicating effective fluid resuscitation. The patient remained stable and was transferred to a specialized burn unit after nine hours. Discussion: The Parkland formula recommends 2-4 mL/kg/%TBSA for fluid resuscitation; however, individualized modifications are often necessary to prevent complications such as over-resuscitation, which can lead to fluid overload and organ dysfunction. This case highlights the importance of adapting the formula based on clinical judgment and patient response. The study also emphasizes the necessity for burn centers to provide standardized protocols to minimize inconsistencies in fluid management. Conclusion: Using a lower fluid volume may be a safer option for fluid therapy in primary care settings, as the risk of overhydration and lung edema practically requires more efforts and contributes worse prognosis than managing the risk of underhydration. Ultimately, we should keep in mind that a patient-centered, dynamically adjusted fluid resuscitation approach still offers the safest and most effective management for burn injuries.