Adrenal hemorrhage in a pediatric burn patient

Adrenal hemorrhage with subsequent insufficiency is a rare complication in the burn patient. The case of a previously healthy 3-year-old Latin America n male who was a victim of child abuse is presented. He suffered a submersi on injury in hot water leading to a 45% total body surface area burn. An ac ute deterioration on the 7th post burn day was unresponsive to standard ino tropic support and cardiopulmonary resuscitation. Post mortem examination r evealed bilateral adrenal hemorrhage that had not been present 2 days earli er. To the authors' knowledge, this is the first reported case in a pediatr ic burn patient. The clinical manifestations of adrenal insufficiency vary widely and can be easily confused with sepsis. High index of suspicion is n ecessary 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 deterio ration resistant to well established resuscitation methods. (C) 2001 Elsevi er Science Ltd and ISBI. All rights reserved.