A 28-year-old woman suffers electrical burns after contact with a high-voltage (>1000 V) wire. She has entry burns on the right hand and exit burns on the left foot. Surface burns appear minimal (<5% TBSA). Which potentially life-threatening complication requires urgent investigation?

• A Inhalation injury
• B Corneal burns
• C Delayed cataracts from voltage exposure
• D Rhabdomyolysis with myoglobinuria and renal failure ✓

Explanation

High-voltage electrical injuries cause massive deep muscle necrosis despite deceptively small surface burns, because current traverses through deeper tissues following the path of least resistance (nerves, blood vessels, muscles). This causes rhabdomyolysis with release of myoglobin, causing acute tubular necrosis and acute kidney injury. Urine should be tested for myoglobinuria (dark urine) and aggressive fluid resuscitation targeting urine output of 1–1.5 mL/kg/hour is essential to flush myoglobin from the tubules.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.