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Abstract：
BACKGROUND: Patients with extensive burns usually develop pro-coagulation soon after the injury if there is no sepsis occurred. We describe the case of an extensive burn adult suffering from hypocoagulation not related to sepsis, but secondary to antibiotic treatment.
METHODS: Here, we report a case of an adult male patient suffering from flame burns of 45% total body surface area (40% full thickness) combined with inhalation injury. Hypocoagulopathy with soaring prolonged activated partial thromboplastin time value occurred on third week post-burn while systemic infection had been under control by application of broad-spectrum antibiotics. Investigations showed that not the infection but vitamin K-related coagulation factor deficiency were responsible for unexpected bleeding. However, supplemental vitamin K was not the key as we expected, which prompted us trying to decode the underlying cause of coagulation disturbance in this patient and pick out the most effective treatment for live-saving. After the withdrawal of highly suspected broad-spectrum antibiotic, Meropenem®, disturbed vitamin K related coagulation factors gradually restored to their optimal levels so as to maintain normal coagulation status. Therefore, surgical procedures without further risk of bleeding could be carried out in time for wound recovery. The patient was discharged on post-burn day 67 and transferred to a secondary hospital for his rehabilitation.
CONCLUSIONS: Hypocoagulopathy may be devoted to different reasons other than sepsis in extensive burns. Early recognition of the cause for coagulation disturbance is critical to make appropriate treatment and save patients\' lives. This case illustrated the importance of unveiling the mist cause for coagulation disturbance occurred in extensive burn patient, which paved the way for optimal life-saving treatments. And we also recommend burn surgeons to be alerted to antibiotic-induced vitamin K deficiency-related coagulopathy among critical burn patients.
METHODS: Here, we report a case of an adult male patient suffering from flame burns of 45% total body surface area (40% full thickness) combined with inhalation injury. Hypocoagulopathy with soaring prolonged activated partial thromboplastin time value occurred on third week post-burn while systemic infection had been under control by application of broad-spectrum antibiotics. Investigations showed that not the infection but vitamin K-related coagulation factor deficiency were responsible for unexpected bleeding. However, supplemental vitamin K was not the key as we expected, which prompted us trying to decode the underlying cause of coagulation disturbance in this patient and pick out the most effective treatment for live-saving. After the withdrawal of highly suspected broad-spectrum antibiotic, Meropenem®, disturbed vitamin K related coagulation factors gradually restored to their optimal levels so as to maintain normal coagulation status. Therefore, surgical procedures without further risk of bleeding could be carried out in time for wound recovery. The patient was discharged on post-burn day 67 and transferred to a secondary hospital for his rehabilitation.
CONCLUSIONS: Hypocoagulopathy may be devoted to different reasons other than sepsis in extensive burns. Early recognition of the cause for coagulation disturbance is critical to make appropriate treatment and save patients\' lives. This case illustrated the importance of unveiling the mist cause for coagulation disturbance occurred in extensive burn patient, which paved the way for optimal life-saving treatments. And we also recommend burn surgeons to be alerted to antibiotic-induced vitamin K deficiency-related coagulopathy among critical burn patients.
摘要：
背景：如果没有败血症发生，大面积烧伤患者通常在损伤后不久就会出现促凝反应。我们描述了一个大面积烧伤的成年人患有与败血症无关的低凝的病例，但继发于抗生素治疗。
方法：这里，我们报告了一例成年男性患者，其全身表面积为45％（整个厚度为40％），并伴有吸入性损伤。烧伤后第三周发生低凝血病，活化部分凝血活酶时间值飙升，而全身感染已通过应用广谱抗生素得到控制。调查表明，不是感染，而是维生素K相关的凝血因子缺乏是意外出血的原因。然而,补充维生素K并不是我们预期的关键,这促使我们试图解码该患者凝血障碍的根本原因，并选择最有效的挽救生命的治疗方法。高度可疑的广谱抗生素停药后，美罗培南®,受干扰的维生素K相关凝血因子逐渐恢复到最佳水平，从而维持正常的凝血状态。因此,没有进一步出血风险的外科手术可以及时进行伤口恢复。患者在烧伤后第67天出院，并转移到二级医院进行康复。
结论：在大面积烧伤中，低凝血症可能与脓毒症以外的不同原因有关。早期识别凝血功能紊乱的原因对于进行适当的治疗和挽救患者的生命至关重要。此案例说明了揭示广泛烧伤患者发生凝血障碍的原因的重要性，为最佳的救命治疗铺平了道路。我们还建议烧伤外科医生注意危重烧伤患者中抗生素引起的维生素K缺乏相关凝血病。
方法：这里，我们报告了一例成年男性患者，其全身表面积为45％（整个厚度为40％），并伴有吸入性损伤。烧伤后第三周发生低凝血病，活化部分凝血活酶时间值飙升，而全身感染已通过应用广谱抗生素得到控制。调查表明，不是感染，而是维生素K相关的凝血因子缺乏是意外出血的原因。然而,补充维生素K并不是我们预期的关键,这促使我们试图解码该患者凝血障碍的根本原因，并选择最有效的挽救生命的治疗方法。高度可疑的广谱抗生素停药后，美罗培南®,受干扰的维生素K相关凝血因子逐渐恢复到最佳水平，从而维持正常的凝血状态。因此,没有进一步出血风险的外科手术可以及时进行伤口恢复。患者在烧伤后第67天出院，并转移到二级医院进行康复。
结论：在大面积烧伤中，低凝血症可能与脓毒症以外的不同原因有关。早期识别凝血功能紊乱的原因对于进行适当的治疗和挽救患者的生命至关重要。此案例说明了揭示广泛烧伤患者发生凝血障碍的原因的重要性，为最佳的救命治疗铺平了道路。我们还建议烧伤外科医生注意危重烧伤患者中抗生素引起的维生素K缺乏相关凝血病。
