Chemical Assault Burns Leading to Multi-organ Complications and End-Organ Damage: A Case Series

This report presents two cases of extensive chemical burn injuries following acute exposure. The first involved a 24-year-old previously healthy female who sustained deep dermal and full-thickness burns over 44% of total body surface area, including the face, neck, chest, and upper limbs. Her injuries were complicated by circumferential limb burns, ocular involvement with corneal damage, and rhabdomyolysis leading to early acute kidney injury. Management required airway protection, aggressive fluid resuscitation, serial debridements, staged skin grafting, and reconstructive surgery. After seven months of hospitalization, she was discharged with stable grafts, preserved limb function, partial visual impairment, and significant scarring. The second case involved a 33-year-old male with 38% full-thickness burns affecting the face, neck, and upper body, accompanied by airway compromise, metabolic acidosis, coagulopathy, rhabdomyolysis, and progressive renal failure necessitating dialysis. Early intubation, escharotomy, and intensive supportive care were instituted. He required prolonged ventilation and multiple grafting and contracture release procedures. After six months, he achieved full clinical recovery. These cases highlight that chemical burns exceeding 30% total body surface area (TBSA) can precipitate overt disseminated intravascular coagulation (DIC), rhabdomyolysis-driven acute kidney injury (AKI), and multi-organ dysfunction even in the absence of initial haemodynamic instability, underscoring the need for early biochemical surveillance protocols and proactive multidisciplinary escalation from the time of presentation.