Survival of near fatal rhabdomyolysis following flame burn in a 25-year-old patient

Abstract

Skin protects the interior of the body from bacterial invasion and is a vital barrier involved in fluid homeostasis. Subcutaneous muscle accounts for approximately 40% of total body mass [1]. Extensive damage such as that associated with flame burn can cause necrosis of vital tissues including the full thickness of skin, subcutaneous fat, muscle, blood vessels, nerves, and bone. Skin necrosis results in loss of the barrier that protects against infection and helps preserve internal fluids. Muscle damage with dissolution of skeletal muscle fiber, rhabdomyolysis, results in release of potentially toxic intracellular components into the systemic circulation [1]. The standard guidelines for early management of shock and prophylaxis of acute renal failure due to rhabdomyolysis have been described [2]. However, most cases of flame burn with rhabdomyolysis have a poor prognosis [3]. The renal complications of rhabdomyolysis occur as the progressive development of hypovolemia, hemoglobinuria, myoglobinuria, oliguria, and eventually, acute renal failure [1,2,4]. The etiology of adult respiratory distress syndrome (ARDS) in burn patients is multifactorial, with evidence suggesting that inhalation injury is a major cause [5]. Most patients with severe burns die due to multiple organ failure and respiratory failure [6]. Preventing the systemic and renal complications of rhabdomyolysis requires very early and vigorous treatment to sustain circulation; preferably, such therapy is started at the site of the catastrophe [1,2,4]. We present the case of a 25-year-old patient who developed fatal rhabdomyolysis