American Board of Surgery Qualifying Exam (ABS QE) Practice Test

What is the recommended treatment for electrical burns with myoglobinuria?

1. Immediate surgery

2. Hydration and alkalinization of urine

3. Skin grafting

4. Corticosteroid therapy

The correct answer is: Hydration and alkalinization of urine

The recommended treatment for electrical burns associated with myoglobinuria focuses on hydration and alkalinization of urine. This approach is essential to prevent acute kidney injury, which is a common complication following severe muscle damage due to electrical burns. Electrical injuries can cause significant rhabdomyolysis, leading to the release of myoglobin into the bloodstream. When myoglobin is filtered through the kidneys, it can cause obstruction and toxicity, resulting in renal impairment. To mitigate this risk, aggressive intravenous hydration helps maintain a high urine output, which dilutes the concentration of myoglobin in the renal tubules. Additionally, alkalinization of the urine can further reduce the nephrotoxic effects of myoglobin by preventing the precipitation of myoglobin casts, which can contribute to renal damage. This proactive management plays a critical role in preserving kidney function after electrical injuries. Other treatments like immediate surgery, skin grafting, or corticosteroid therapy do not address the underlying risk of renal complications from myoglobinuria and are therefore not the primary focus in the acute management of electrical burns with this complication.