Around 21:00 on March 12, 2021, 15-year-old Tran Ngo Duc H., in Dai Mo, Bac Tu Liem, Hanoi, playfully burned alcohol bottles, igniting clothes, causing burns with an area of ​​28% (7%). grade II, III, IV face, neck, chest, abdomen, two hands, severe burn shock 1st hour; After the burn, the child was soaked in cool water, applied ice to the burn and transferred to the National Burns Hospital in a state of alertness, nervous excitement, pale skin and lips, cold limbs, thirst, weight 50kg. Check body temperature: 37 degrees Celsius, pulse 130 times/1 minute, blood pressure 130/80mmHg, haven't urinated since the burn.

Through taking the history, the patient was previously born prematurely, weighed 1.6kg at birth, had mental retardation, and could only talk and walk at the age of 3. In 2017, he was found to have hypopituitarism, hypothyroidism, and was treated as an outpatient at the National Children's Hospital. After combined hormone therapy, the patient grows in height, normal weight, mental retardation, dry skin, hair loss, fatigue, lethargy.

Newly admitted patient

The patient, when admitted to the hospital with burn shock, was actively resuscitated by doctors of the Children's Burn Department according to the anti-shock regimen: Warming, oxygen support, Ringerlactate infusion according to Parkland's formula in children, total amount Fluid in the first 24 hours is 4 ml/kg/% burn area, plasma transfusion (12 hours after burn), pain relief, cardiovascular support, systemic antibiotics, potassium replacement to prevent gastrointestinal ulcers, active nutrition ( early nutrition of the gastrointestinal tract). At the same time, the patient continued to take the combined treatment of the National Children's Hospital with hypopituitarism and hypothyroidism.

Master Nguyen Bang Tam, the doctor who directly treated the patient, said that during the treatment, the patient was supplemented with plasma infusion, sodium supplement, Anson and Mepilex Ag membrane covering the wound, these are the membranes that cover the wound. Very good wound is used in the treatment of burns and wounds, and the patient is undergoing necrotizing surgery and skin grafting.

After 47 days of treatment, the patient's burn injury completely healed, the patient was transfused with 1700ml of plasma, 350ml of red blood cells. After the burn injury healed, the child was transferred to the Rehabilitation Department of the Hospital on April 28, 2021 for further treatment of motor function.

The pituitary gland is an important endocrine gland in the body, it plays a role in directing the activities of most other endocrine glands; When hypopituitarism leads to a deficiency of GH hormone, it affects the growth of bones as well as the overall development of the body, thus affecting the healing process of wounds/burns.

At the same time, when the pituitary gland is insufficiency, it will cause a lack of thyroid-stimulating hormone (TSH), causing hypothyroidism, making children's intelligence reduced, resistance reduced, on the other hand, skin cells are also very sensitive to the signal of thyroid weakness. , when the normal skin regeneration cycle is broken, the skin takes a long time to recover, which slows down the healing process of burns/wounds.

When hypothyroidism causes a decrease in ACTH, cortisol can cause hypotension, so care must be taken during surgical anesthesia

Treatment of pediatric patients with large-scale burns is always a big challenge in treatment, with a high mortality rate and expensive treatment costs. On this patient, when admitted to the hospital, a confirmed diagnosis was established and a reasonable treatment plan, aggressive anti-shock, and appropriate antibiotic tactics were established in accordance with the clinical and subclinical progression of the disease. according to the scheme. Combining early systemic nutrition, planning early necrosis surgery, skin grafting, and early rehabilitation for the patient.

Nguyen Bang Tam, Children's Burn Treatment Department, National Burn Hospital