LETTER TO EDITOR
|Year : 2010 | Volume
| Issue : 1 | Page : 45-46
Acute renal failure following electrocution
Hareesh S Gouda, Binaya Kumar Bastia
Department of Forensic Medicine and Toxicology, J.N. Medical College, Belgaum, Karnataka, India
|Date of Web Publication||31-Jan-2012|
Hareesh S Gouda
Department of Forensic Medicine and Toxicology, J.N. Medical College, Belgaum - 590 010, Karnataka
|How to cite this article:|
Gouda HS, Bastia BK. Acute renal failure following electrocution. Indian J Med Sci 2010;64:45-6
Acute renal failure (ARF) is not a common fatal complication of electrocution. In such cases, myoglobin, released into the bloodstream due to rhabdomyolysis following electrical injury to the muscles, is often blamed as the offending agent. Electrical injury patients have a little risk of developing ARF, but will have the contrary if rhabdomyolysis occur. The reason is that ARF is the most important complication of rhabdomyolysis. 
A 23-year-old man, who accidentally received high voltage electrical injury, was referred from a peripheral health center to the Emergency Department of our hospital after 4 days of incident. Laboratory investigation on the day of admission revealed: blood urea - 18 mg/dL, serum creatinine - 1.1 mg/dL, serum potassium - 4.1 mEq/L, and normal urine result. As the basic investigations were within the normal limit, the patient was treated for the burns and monitoring of the vital functions with particular reference to cardiac function was advised. However, after 3 days of admission, a significant rise in the above parameters was observed: blood urea - 42 mg/dL, serum creatinine - 4 mg/dL, and blood potassium - 6.1 mEq/L. One more clinically significant finding observed was the detection of myoglobin in the urine (urine myoglobin - 107 mg/L). Further blood test revealed high serum creatine kinase level (1123 IU/L) suggestive of rhabdomyolysis. The patient was treated with the accepted method of treatment for rhabdomyolysis induced ARF. Unfortunately, the patient died on the fourth day of admission (8 days after the accident) due to ARF secondary to rhabdomyolysis following electrical injury.
Autopsy revealed 40-45% superficial and deep electrical burns, entry wounds in both upper limbs near the armpits, exit wounds in both the feet; pre-gangrenous and gangrenous changes in the left and right upper limb respectively with muscle necrosis; generalized anasarca, pitting edema; cerebral and pulmonary oedema; obliteration of normal renal architecture; and increased weight of both kidneys. Histopathological examination of kidney confirmed the diagnosis.
The literature states that in electrocution, immediate death occurs when a vital organ like brain or heart comes in the circuit or path of current. In this particular case, even though there was a possibility of electrical current passing through the heart, the deceased escaped the immediate death. Instead, he died due to the damage caused to kidneys as a result of electrical injury to the muscles. Muscle may be damaged either directly from electrical current or due to ischemia following injury to the blood vessels. The result, whatever the mechanism, is muscle necrosis and gangrene.  The pathophysiological mechanisms in ARF due to rhabdomyolysis are, renal vasoconstriction, intraluminal cast formation, and direct myoglobin toxicity. Rhabdomyolysis is an important cause of ARF and remains unrecognized in many cases. Around 33% of the episodes of rhabdomyolysis lead to ARF. 
Injury to the solid abdominal organs directly from electrical current is rare and an uncommon cause of death in such cases. But, there is always a likelihood of death resulting from the indirect injury to these organs due to electrocution. In a study done on patients with ARF following electrical injury, it was observed that myoglobinuric ARF carries a high mortality.  Hence, the possibility of renal damage needs to be addressed clinically in cases of deep electrical burns with muscular damage.
In the present case, initial delay in the proper treatment at the primary health centre level might have contributed to the irreversible damage to the kidney and subsequent ill-fated outcome. Although the rhabdomyolysis-induced ARF is a rare complication of electrocution, if develops proves fatal.
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