Pathological and biochemical analysis of the pathophysiology of fatal electrocution in five autopsy cases.

Five autopsy cases involving electrocution were examined to determine the pathophysiology of death. Cases 1-4 (industrial accidents: about 160-3800 V-AC) showed pathological findings of acute death, whereas Case 5 (suicide: 100 V-AC) showed those of subacute death. Electrical marks were observed as collapsed blisters with/without charring in Cases 1-4, and markedly charred burns with erythema in Case 5. There was evident cardiomyolysis in Cases 3 and 4, and marked congestive edema of the lungs in Cases 3 and 5. In postmortem biochemistry, a peculiar elevation of creatine kinase-MB in the heart blood was seen in Cases 1 and 2, suggesting myocardial cytoplasmic membrane injury. In Cases 3 and 4, showing cardiomyolysis, cardiac troponin I was markedly elevated in the heart and peripheral blood, suggesting cardiac myofibrillary injury. Case 5 showed findings of prolonged hypoxia and skeletal muscle injury involving elevations in serum uric acid and creatinine, and a typical pattern of acute respiratory distress in pulmonary surfactant immunostaining. These findings suggest that the main fatal factors were acute circulatory failure following myocardial injury in Cases 1 and 2, more advanced myocardial injury in Cases 3 and 4, and respiratory failure due to skeletal muscle injury in Case 5. The present study suggested that the mode of death due to electrocution might be closely related to the macromorphology of electrical marks.