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Consequences and complications after burns
Last reviewed: 07.07.2025
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Systemic complications after burns
The larger the burn area, the higher the risk of systemic complications. Risk factors for both complications and death include burns >40% of body surface area, age >60 years or <2 years, concomitant severe trauma, and inhalation injury.
The most typical systemic complications are hypovolemia and infection. Hypovolemia, leading to insufficient blood supply to the burned tissues and sometimes to shock, may be a consequence of fluid loss from the surface of deep and extensive burns. Hypoperfusion of burned tissues may also be a consequence of direct damage to blood vessels or vascular spasm, secondary hypovolemia. Infection, even with minor burns, often causes sepsis and death, as well as local complications. Impaired protective reactions of the body and tissue devitapization enhance bacterial invasion and growth. In the first few days, streptococci and staphylococci are most common, in the next 5-7 days - gram-negative bacteria; but in almost all cases, mixed flora is detected.
Metabolic disturbances may include hypoalbuminemia, due partly to hemodilution (due to fluid replacement) and partly to protein leakage into the extravascular space through damaged capillaries. Hypoalbuminemia and hemodilution contribute to hypocalcemia, but ionized calcium concentrations usually remain within the normal range. Other electrolyte deficiencies may occur, including dilutional hypomagnesemia, hypophosphatemia, and, particularly in patients taking potassium-wasting diuretics, hypokalemia. Extensive tissue destruction may lead to hyperkalemia. Metabolic acidosis may result from shock. Rhabdomyolysis and hemolysis result from deep thermal and electrical burns of muscle or from muscle ischemia due to contraction of the eschar. Rhabdomyolysis causes myoglobinuria, and hemolysis causes hemoglobinuria, which may ultimately lead to acute tubular necrosis.
Hypothermia may develop after the intravenous administration of large amounts of cool fluid, and exposure of uncovered body parts to cool air and objects in the emergency department, especially with extensive burns. Ventricular arrhythmias may develop secondarily in the setting of electrolyte disturbances, shock, metabolic acidosis, and sometimes hypothermia, as well as in patients with inhalation injuries. Intestinal obstruction is common after extensive burns.
Local complications after burns
Circular third-degree burns of the extremities lead to the formation of constricting scabs, which can contribute to the development of local ischemia, and in the chest area - to respiratory disorders.
Spontaneous healing of deep burns results in excessive granulation tissue formation, causing further scarring and contractures; if the burn is near a joint or on the hand, foot, or perineum, this can lead to severe functional impairment. Infections can stimulate the scarring process. Keloid scars form only in certain groups of patients, especially blacks.