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Adrenal hemorrhage in a pediatric burn patient
S A Deeb1, R B Rosenberg, R J Wilkerson
1Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center and the, 3601 4th Street, Lubbock, TX 79430-0001, USA. sursad@ttuhsc.edu
Insights
Adrenal hemorrhage is a rare but fatal complication in pediatric burn patients. Early diagnosis and steroid treatment are crucial for survival when sepsis-like symptoms appear.
Area of Science:
- Pediatric Critical Care
- Burn Medicine
- Endocrinology
Background:
- Adrenal hemorrhage leading to adrenal insufficiency is a rare complication in burn patients.
- Child abuse can result in severe burn injuries, as seen in this case.
Observation:
- A 3-year-old boy with a 45% total body surface area burn experienced sudden deterioration on post-burn day 7.
- The patient's condition was unresponsive to standard resuscitation and inotropic support.
- Post-mortem examination revealed bilateral adrenal hemorrhage, not present two days prior.
Findings:
- This is the first reported case of adrenal hemorrhage and insufficiency in a pediatric burn patient.
- Clinical signs of adrenal insufficiency can mimic sepsis, complicating diagnosis.
- Prompt diagnosis and intervention with steroid therapy are vital.
Implications:
- A high index of suspicion for adrenal insufficiency is necessary in pediatric burn patients with unexplained deterioration.
- Measuring serum cortisol levels and initiating steroid therapy can improve survival rates.
- This case highlights the importance of considering adrenal complications in severe burn cases, especially those involving trauma.
Abstract:
Adrenal hemorrhage with subsequent insufficiency is a rare complication in the burn patient. The case of a previously healthy 3-year-old Latin American male who was a victim of child abuse is presented. He suffered a submersion injury in hot water leading to a 45% total body surface area burn. An acute deterioration on the 7th post burn day was unresponsive to standard inotropic support and cardiopulmonary resuscitation. Post mortem examination revealed bilateral adrenal hemorrhage that had not been present 2 days earlier. To the authors' knowledge, this is the first reported case in a pediatric burn patient. The clinical manifestations of adrenal insufficiency vary widely and can be easily confused with sepsis. High index of suspicion is necessary for early diagnosis and treatment. Serum cortisol level should be checked and steroid therapy implemented if sepsis syndrome is unresponsive to standard therapy in this setting. This early intervention may be the key to improved survival of the burn patient with a sudden unexplained deterioration resistant to well established resuscitation methods.
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