Early initiation of high-volume hemofiltration may reduce complications of high-voltage electrical injuries: A case report
Christopher T. Buckley,
Sai R. Velamuri,
Ibrahim Sultan-Ali,
Faisal Arif,
William L. Hickerson,
David M. Hill
Affiliations
Christopher T. Buckley
Department of Pharmacy, College of Pharmacy, Union University, 1050 Union University Drive, Jackson, TN 38305, USA
Sai R. Velamuri
Department of Plastic Surgery, Firefighters Regional Burn Center, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA; Department of Plastic Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38103, USA
Ibrahim Sultan-Ali
Department of Medicine, Firefighters Regional Burn Center, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA; Department of Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
Faisal Arif
Department of Medicine, Firefighters Regional Burn Center, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA
William L. Hickerson
Department of Plastic Surgery, Firefighters Regional Burn Center, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA; Department of Plastic Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38103, USA
David M. Hill
Department of Pharmacy, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA; Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Ave, Memphis, TN 38163, USA; Corresponding author at: Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA.
The purpose of this case was to report the impact of early use of high-volume hemofiltration on a previously healthy male admitted after sustaining a high-voltage electrical injury. Initial labs revealed acute kidney injury secondary to rhabdomyolysis with myoglobinuria. The patient required fasciotomies to the three affected extremities and a right above the elbow amputation. Aggressive fluid resuscitation failed to maintain urine output above 20 mL/h. By 24 h, the patient had a 12.8 L positive fluid balance. High-volume hemofiltration was initiated at 60 mL/kg/h using a system with a high cut-off filter for acute kidney injury and volume management. Urine myoglobin was negative by day 3 and serum myoglobin decreased to 221.46 nmol/L. He was extubated on day 5, achieved euvolemia on day 6, and high-volume hemofiltration was discontinued on day 13 with subsequent full renal recovery. He underwent several staged surgeries for burn wound excision and grafting, and the left lower extremity was salvaged. His length of stay was prolonged due to multiple social barriers, but free of sepsis and pneumonia. Early initiation of high-volume hemofiltration with a high cut-off filter helped to expedite removal of acute kidney injury and enable more effective volume management to minimize complications of high-voltage electrical injury and its treatment and likely improve outcomes.
