Benjamin Chia1, Dr Samuel Chu2, Dr Rachael Baines2, Dr Helen Douglas2, Dr Edward Raby2, Dr Fiona Wood2
1University of Western Australia – School of Medicine, Perth, Australia, 2Fiona Stanley Hospital – State Burns Service of Western Australia , Perth, Australia
We present a 24-year-old male with a 45% TBSA flash accelerant burn to his face, and bilateral upper and lower limbs. No medical or surgical history was reported on questioning.
Neutropaenia on day 3 was noted, and lactate in the range of 2-3 despite adequate fluid resuscitation. He underwent debridement, split skin grafting and ReCell on day 5 and developed hyperlactataemia of 12.1 intra-operatively despite minimal blood loss. He remained intubated to aid respiratory compensation and was transferred to the intensive care unit post-operatively. His hyperlactataemia resolved over 48 hours and he was eventually discharged on day 18.
Collateral history revealed he had undergone sleeve gastrectomy 6 years prior and had lost 50kg. Subsequent bloodwork revealed micronutrient deficiencies which were corrected.
Malnutrition secondary to bariatric surgery may have consequences on the severity of burns (Michalak et al. 2021; Wang, Zhang & Li 2018). Eliciting this information is vital as patients may not volunteer this due to perceived stigma (Jumbe, Hamlet & Meyrick 2017, Vartanian & Fardouly 2014).
Hyperlactataemia can be caused by tissue hypoperfusion (Type A), or impaired cellular metabolism (Type B) (Emmet & Szerlip, 2021). Type A can be caused by hypovolaemia secondary to blood loss, however this was not the case in our patient. Type B is associated with diabetes, alcoholism, and HIV; none of which applied to our patient. It is also associated with mitochondrial dysfunction, which can be due to micronutrient deficiencies.
The literature surrounding this type of case and implications for the future will be discussed.
Michalak M, Pierzak M, Kręcisz B, Suliga E. Bioactive Compounds for Skin Health: A Review. Nutrients. 2021; 13(1):203.
Wang XX, Zhang MJ, Li XB. Zhonghua Shao Shang Za Zhi. 2018;34(1):57-59.
Jumbe, S, Hamlet, C, Meyrick J. 2017. Psychological aspects of Bariatric surgery as a Treatment for Obesity. Curr Obes Rep; 6(1): 71-78
Vartanian, LR & Fardouly, J. 2014. Reducing the stigma of bariatric surgery: benefits of providing information about necessary lifestyle changes. Obesity May 22(5):1233-7
Emmett, M. Szerlip, H. Causes of lactic acidosis. In: R Sterns, JP Forman, editors. UpToDate [Internet]. Waltham (MA): UpToDate Inc; 2021.
Dr Samuel Chu is a service registrar working at Fiona Stanley Hospital with the State Burns Service of Western Australia. He has a keen interest in Plastic Surgery.