History and clinical findings: A group of six hikers were hit by lightning out of the blue sky. The biggest harm was done to a 29-year-old man (size: 190 cm) while walking along a high spruce. He experienced a seizure with consecutive sinus tachycardia and hypertensive dysregulation. One year later he still complained about reduced physical strength. The other five hikers had less severe injuries.
Investigations: Burns were detectable in five of six patients. Elevated creatine kinase and myoglobin were indicative for myolysis. Renal parameters were normal.
Diagnosis, therapy and course: All patients were treated with intravenous fluid and electrolyte substitution during transport to hospital. Two patients were additionally treated with metroprolol.
Conclusion: Cardiac arrhythmias, usually tachycardia, myolysis, and seizures require early treatment with beta blockers, sufficient fluid supply, and antiepileptics. In patients with cardiac arrest after a lightning injury immediate cardiac resuscitation is crucial.