Papers from the 2017 JMS Burn SymposiumVolume Resuscitation in Patients With High-Voltage Electrical InjuriesCulnan, Derek M. MD*; Farner, Kelley NP*; Bitz, Genevieve H. BS*; Capek, Karel D. MD†; Tu, Yiji MD‡; Jimenez, Carlos MD, FACS†; Lineaweaver, William C. MD, FACS* Author Information From the *JMS Burn and Reconstructive Center, Merit Health Central, Jackson, MS; †Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children—Galveston, Galveston, TX; and ‡Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. Received December 5, 2017, and accepted for publication, after revision January 4, 2018. Conflicts of interest and sources of funding: None declared. Reprints: Derek M. Culnan, MD, Merit Health Central, 1850 Chadwick Dr, Suite 1427, Jackson, MS 39204. E-mail: [email protected]. Annals of Plastic Surgery 80(3):p S113-S118, March 2018. | DOI: 10.1097/SAP.0000000000001374 Buy Metrics Abstract Volume resuscitation of patients with high-voltage electrical injuries (>1000 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 and secondary compartment syndromes can result in rhabdomyolysis, compromising renal function and urine output. Urine output is the primary end point, with a goal of 1 mL/kg/h for adult patients with high-voltage electrical injuries. As such, secondary resuscitation end points 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. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.