Fluid Management in Electrical Burns
For electrical burns, initial fluid resuscitation should follow the modified Parkland formula of 3-4 mL/kg/%TBSA, with adjustment based on clinical response and monitoring parameters including urine output of 0.5-1 mL/kg/hour. 1
Initial Fluid Resuscitation Approach
- Adult patients with burns ≥10% TBSA and pediatric patients with burns ≥5% TBSA require formal fluid resuscitation 1
- The recommended initial fluid is a balanced crystalloid solution, with Ringer's Lactate being the preferred choice 2
- For immediate management, administer 20 mL/kg of crystalloid within the first hour to address early hypovolemic shock 2
- After initial bolus, calculate 24-hour fluid requirements using the Parkland formula (2-4 mL/kg/%TBSA) 1
Special Considerations for Electrical Burns
- Electrical burns often cause deeper tissue damage than is apparent on the surface, potentially requiring higher fluid volumes than thermal burns 1
- Patients with electrical burns frequently have deeper tissue injury and may develop compartment syndrome requiring careful monitoring 2
- Monitoring for myoglobinuria is essential as electrical burns cause significant muscle damage, which may require additional fluid to prevent acute kidney injury 1
Fluid Administration Schedule
- Half of the calculated 24-hour fluid requirement should be given in the first 8 hours post-burn, with the remaining half over the next 16 hours 3, 1
- The timing of fluid resuscitation is critical - early administration (within 2 hours) has been shown to reduce morbidity and mortality 2
- Intravenous access should be obtained as soon as possible, preferably in unburned areas 2
Monitoring and Adjustment Parameters
- Urine output is the simplest parameter to monitor, targeting 0.5-1 mL/kg/hour 1, 4
- Additional monitoring should include:
Avoiding Complications
- "Fluid creep" (excessive fluid administration) must be avoided as it can lead to complications including compartment syndrome 1, 5
- Under-resuscitation may lead to organ failure and death 6
- If hypotension persists despite adequate fluid resuscitation, evaluate cardiac function and consider vasopressors 1
- For patients with circumferential third-degree burns, monitor for compartment syndrome which may require escharotomy within 48 hours if circulatory impairment develops 2
Adjusting for Patient Factors
- Children require proportionally more fluid than adults due to higher surface area-to-weight ratio 3, 1
- Patients with deep burns require higher fluid volumes than those with superficial burns 7
- Fluid requirements show negative correlation with body mass index and total burn surface area percentage 7
- Patients with inhalation injuries require significantly more fluid (approximately 5.0±1.3 vs 3.9±0.9 mL/kg/%TBSA) 5
Practical Implementation
- For electrical burns with significant muscle damage, maintain higher urine output (1-2 mL/kg/hour) to prevent myoglobin-induced renal injury 1
- Reassess fluid requirements hourly in the first 24-48 hours and adjust based on clinical response 4
- Consider transpulmonary thermodilution monitoring in severe cases to guide resuscitation and avoid over-resuscitation 4