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Hydration is the key to reducing
the morbidity of electrical injury. If muscle damage is significant, the use of an osmotic
diuretic is also indicated. Drug Category: Fluids
Loss of intravascular volume through the damaged epithelium, as well as loss into
extravascular spaces requires fluid resuscitation. This is best be acheived with Lactated
ringers.
| Drug Name |
Lactated ringers - It is essentially
isotonic and has volume restorative properties. |
| Adult Dose |
Generally administer 10 ml/kg/h during
initial resuscitation. |
| Pediatric Dose |
Use the same regimen as in adults. |
| Contraindications |
The major complication of isotonic fluid
resuscitation is interstitial edema. Edema in an extremity is unsightly, but not a
significant complication. Edema in the brain or lungs is potentially fatal. The major
contraindication to isotonic fluid resuscitation is pulmonary edema in which the added
fluid promotes more edema. |
| Interactions |
No significant drug interactions have been
reported with this product. |
| Pregnancy |
C - Safety for use during pregnancy has not
been established. |
| Precautions |
Fluid resuscitation will be expected to
exacerbate cerebral edema. Fluids should be
stopped when the desired hemodynamic response is seen or pulmonary edema develops. |
Drug
Category: Osmotic Diuretics
If myoglobinemia and myoglobinuria are present, acute renal
failure can be minimized by the addition of mannitol to the regimen of fluid
resuscitation.
| Drug Name |
Mannitol (Osmitrol) - It is an osmotic
diuretic which is not significantly metabolized and which passes through the glomerulus
without being reabsorbed by the kidney. |
| Adult Dose |
50-200 g/24 h IV Adjust the dose to maintain a urinary output of 30-50 mL/h |
| Pediatric Dose |
Under 12 y: Safety and efficacy have not
been established. However, trial doses of
0.2g/Kg IV followed by careful monitoring of urinary output may be prudent, again with the
goal of producing diuresis in the child with myoglobinuria |
| Contraindications |
Well established anuria due to severe renal
disease. Severe pulmonary edema.
Active intracranial bleeding except during craniotomy.
Severe dehydration.
Progressive renal damage or dysfunction after institution of
mannitol therapy, including increasing oliguria and azotemia.
Progressive heart failure occurring after institution of
mannitol therapy |
| Interactions |
No significant drug interactions have been
reported with the use of this product. |
| Pregnancy |
C - Safety for use during pregnancy has not
been established. |
| Precautions |
Severe electrolyte imbalance and dehydration
can ensue if a careful monitoring of electrolyte status is not performed. |
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