A 2-year, 2-month-old boy was admitted at an interval of 10 h with burns of 40% BSA (trunk, abdomen, legs, and hands) []. On admission, he was in gasping condition and was immediately intubated and ventilated. He had ventricular tachycardia, very poor perfusion, severe metabolic acidosis, and refractory hypotension. Postresuscitation, he was commenced on multiple inotropes. Similar to Case 2, he developed intravascular hemolysis with hemoglobinuria. Hemodialysis was initiated on D2, and because of hemodynamic instability, sustained low-efficiency dialysis was chosen as the modality. His liver function also worsened and needed N-acetylcysteine infusion with supports of various blood products. He also started having refractory convulsions which required multiple antiepileptic drugs. Both liver and renal function improved slowly. He was extubated at 9 days of mechanical ventilation, hemodialysis discontinued after 12 cycles, and ultimately discharged after 24 days of hospital stay. At 10-month follow-up, he is doing well with normal renal function, healing skin lesion, and mild neurological sequelae.
A 1-year, 6-month-old boy was presented to us 8 h postexposure with burn of 20% BSA involvement including the lower part of the face and anterior chest wall. After initial resuscitation including intubation and ventilation, he was hyperhydrated assuming the possibility of acute kidney injury (AKI) secondary to pigment nephropathy, but in spite of this, his urine output started falling from day 2 of admission, and hemoglobinuria became obvious along with rising creatinine from 0.28 to 0.98 mg/dl. Furosemide infusion was started to maintain urine output >1.5 ml/kg/h, and slowly with judicious fluid support and furosemide infusion, urine started clearing from 4th day of admission and creatinine normalized. Evaluation of the gastrointestinal tract by endoscopy revealed esophagus Grade 2b and stomach Grade 2a burn injury. He was extubated by day 6 of mechanical ventilation. He was initially kept on total parenteral nutrition for 7 days and thereafter started on clear liquids which were gradually built up to semi-solid. Solids were initiated after 6 weeks, once repeat endoscopy revealed normal esophageal and gastric mucosa. At present, he is doing well without any long-term complication.\nAccording to the parents/onlookers, none of the children ingested significant amount of carbolic acid as they spitted it out immediately, and the majority of the carbolic acid was splattered on their various body parts.