Electrolyte changes caused by hydrotherapy in purpura fulminans.
Purpura fulminans is a rare manifestation of meningococcemia that in its full-blown form has a predictive death value of 61%. Those patients who survive usually develop gangrenous lesions that involve skin and underlying structures, mostly of the extremities and sometimes of the cheeks. Experience with early excision and skin grafting of these lesions has generally been unsatisfactory since, due to the unique pathophysiology of the disease and involvement of the most distal branches of the cutaneous circulation, the lesions are not completely demarcated until well after complete recovery from the acute phase of the disease. Recently there was an outburst of purpura fulminans in Southern California and other parts of the country. During the months of January and February 1986 we were consulted on five cases. These ranged from two months to six years in age and consisted of two boys and three girls. One two-month-old died during the acute phase, another six-year-old remained in shock and in need of hemodynamic and respiratory support and succumbed three weeks after the onset of the disease, during which time all four extremities showed progressive necrosis. Of the three patients that survived, one three-year-old girl resolved her purpuric lesions except for small necrotic patches on the buttocks that did not require surgical intervention. The other two children were left with gangrenous lesions of the upper and lower extremities over 30% of total body surface area. One of these two patients demonstrated an electrolyte disturbance.(ABSTRACT TRUNCATED AT 250 WORDS)
Abrams
R S
RS
Division of Plastic Surgery, Childrens Hospital of Los Angeles, CA 90054-0700.
Nichter
L S
LS
Sloan
G M
GM
Holdrege
S
S
D002675:Child, Preschool; D005260:Female; D006801:Humans; D006875:Hydrotherapy / Q000009:adverse effects*; D007010:Hyponatremia / Q000209:etiology*; D011693:Purpura / Q000401:mortality / Q000628:therapy*