A 25-year-old electrician sustains a high-voltage injury with small entry and exit wounds over the hand and foot but extensive deep muscle destruction and dark brown urine. Total body surface area by surface wounds is only 8 percent. Fluid resuscitation in the first hours should be guided primarily by:
- A Urine output, targeting 75 to 100 mL per hour in adults until the urine clears ✓
- B The Parkland formula calculated from the visible TBSA
- C Serial serum sodium measurements
- D Haemodynamic response to a fixed 500 mL colloid bolus protocol
Correct answer: A. Urine output, targeting 75 to 100 mL per hour in adults until the urine clears
Explanation
Electrical injuries destroy deep muscle far out of proportion to visible skin marks, so formulas based on TBSA grossly underestimate fluid needs. Resuscitation is titrated to urine output, aiming for 75 to 100 mL per hour in adults with pigmenturia, and mannitol or increased rates are used to protect against myoglobin-induced acute tubular necrosis until the urine clears. Serum sodium guides electrolyte correction rather than volume, and fixed bolus protocols ignore ongoing rhabdomyolysis. Cardiac monitoring for arrhythmia is separate and does not guide fluids.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.