Hiroshi Matsuura1*, Akinori Osuka2, Hiroshi Ogura1, Masashi Ueyama2 and Takeshi Shimazu1
A 28-year-old man suffered intentional dermal exposure to potassium hydroxide inside a psychiatric hospital bathroom during inpatient treatment for schizophrenia. He received initial treatment at a local emergency department (ED) and was transferred to our burn unit. On arrival at 18 hours after the injury, he was diagnosed as having 60% total body surface area (TBSA) chemical burns; third-degree: 24%, second-degree: 36%. At the outside ED, his serum potassium level peaked at 8.2 mEq/L (normal range: 3.5 to 5.0 mEq/L) and decreased to 6.9 mEq/L after he received intravenous glucose and insulin therapy. At our facility his potassium had increased to 7.3 mEq/L. The patient’s urine output was maintained at >100 mL/h, but his serum potassium level rose to 8.1 mEq/L and continuous hemodiafiltration was initiated within 5 h of admission. Early debridement was performed due to extensive thirddegree burns, risk of deep-tissue alkali injury, and persistent (chemical-induced) hyperkalemia. At 40 h after the injury, fascial resection of the lower leg was performed, involving 20% TBSA third-degree burn, and his serum potassium normalized. After five operations he was able to ambulate with assistance, and on hospital day 72 he was transferred to a rehabilitation hospital without major complications.
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