Deep Electrical Burn Complicated by Anuria and Pseudomonas Septicaemia

Abstract

Deep electrical burns of the upper limbs were sustained by a young man who had previously been in good health. Primarily the patient was delirious and restless, but did not exhibit signs of shock. The extent of the 2nd and 3rd degree burns was estimated to be 16%. In spite of fluid-electrolyte therapy in sufficient quantity, oliguria appeared a few hours after the accident, and myoglobinuria was demonstrated during the first days. After decompressing incisions had been made into both arms, the burns were treated conservatively with dressings. Five weeks after the accident, excision and grafting were done. There proved to be coagulation necroses of the greater part of the muscles on both upper limbs, and the left forearm had to be amputated. The uraemia was treated with a total of five haemodialyses and one peritoneal dialysis. At the end of 4 weeks the renal function improved, and 3 months after admission it had returned to normal. The course was complicated by pseudomonas septicaemia. In spite of the persisting oliguria the patient was treated with a total of 8450 mg polymyxin B in 38 days. The maximum serum level amounted to 31 i.u. ml. The treatment entailed drug fever and toxic signs from the central nervous system which promptly disappeared after polymyxin was discontinued. The clinical course and the treatment are discussed.