A 60 kg electrician sustains deep contact burns from a high-voltage line involving both forearms. The surface area appears to be only 12% TBSA, but there is extensive myonecrosis and dark brown urine. Fluid resuscitation should be titrated to achieve what urinary output?
- A 0.5 mL/kg/hour
- B 1.0 to 1.5 mL/kg/hour, increased further until pigmented urine clears ✓
- C 30 mL total per hour regardless of weight
- D Urine output is irrelevant; fluid should follow the calculated Parkland volume exactly
Correct answer: B. 1.0 to 1.5 mL/kg/hour, increased further until pigmented urine clears
Explanation
Electrical injuries cause deep muscle damage far beyond the visible skin burn, so formulas based on TBSA underestimate requirements. Resuscitation is titrated to a urine output of about 1 to 1.5 mL/kg/hour in adults, and when myoglobinuria is present the target is raised (often up to 75 to 100 mL/hour) with alkalinisation considered until the urine clears. Option A is the target for superficial thermal burns under the modified Brooke approach, not electrical injury.
Reference: Sabiston Textbook of Surgery, 21st ed.
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