Volume resuscitation in patients with high-voltage electrical injuries

Volume resuscitation of patients with high-voltage electrical injuries (>1,000 V) is a more complex challenge than standard burn resuscitation. High voltages penetrate deep tissues. These deep injuries are not accounted for in resuscitation formulae dependent on percentage of cutaneous burn. Myonecrosis occurring from direct electrical injury as well as secondary compartment syndromes can result in rhabdomyolysis, compromising renal function and urine output. Urine output is the primary endpoint, with a goal of 1 cc/kg/hr for adult patients with high-voltage electrical injuries. As such, secondary resuscitation endpoints of laboratory values, such as lactate, base deficit, hemoglobin, and creatinine, as well as hemodynamic monitoring, such as mean arterial pressure and thermodilution techniques, can become crucial in guiding optimum administration of resuscitation fluids. Mannitol and bicarbonates are available but have limited support in the literature. High-voltage electrical injury patients often develop acute kidney injury requiring dialysis and have increased risks of chronic kidney disease and mortality. Continuous venovenous hemofiltration is a well-supported adjunct to clear the myoglobin load that hemodialysis cannot from circulation.