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 14-month-old girl was admitted 8 h postaccidental spillage of carbolic acid. On admission, she had acidotic breathing with a Glasgow Coma Scale of 9/15, convulsion, and blackish-blue discoloration of the skin of left thigh, trunk, and a portion of left hand involving a total of 25% of BSA. Topical glycerine was applied on the exposed parts. After 24 h of admission, she became oliguric and started passing dark brownish urine, and creatinine progressively increased from 0.11 to 3.18 mg/dl, along with the evidence of intravascular hemolysis []. Hemodialysis was initiated on day 3 of admission, but fortunately could be discontinued after four cycles as renal parameter started improving. At last 9-month follow-up, she had normal renal parameters with healing skin lesions.