Renal function

In the presence of extensive striated muscle damage there is release of myoglobin into the blood. Myoglobin is a low-molecular-weight protein which is filtered by the glomerulus and appears in the urine where it usually, but not always, produces a brown coloration. In the presence of myoglobin, urine will test positively for blood although there may be no microscopic evidence of red cells. In these circumstances renal failure may be averted by increasing the intravenous infusion rate to improve urine flow, using mannitol, and alkalinizing the urine (up to 500 ml/h of 1.26 per cent sodium bicarbonate) to a pH above 6. Other evidence of rhabdomyolysis is a plasma creatinine that is disproportionately high compared with urea. In these circumstances it is important to identify the source of the myoglobin and to perform appropriate fasciotomies or excise dead muscle.

Neurological function

Neurological disorders are seen more often after high-voltage injury than after low-voltage injury. Unconsciousness, seizures, and coma may result, with persistence of neurological deficit and cerebral edema in some victims. Giyb®,and,§ch,n(i19.9.2). described no sequelae in 87 per cent of patients with only transient loss of consciousness but a generally bad outcome after prolonged coma. Immediate or delayed peripheral neuropathy occurred in a significant number of patients.

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