Complications
On admission, the hydration status of the patient needs to be assessed. If they have stomatitis, nausea, or vomiting, they are more likely to be dehydrated. With a history of rash/stomatitis for several days prior to hospitalisation without treatment, they may also be at risk for dehydration. Also, depending on the extent of the skin sloughing, they may be losing fluids through their denuded skin surface. Electrolyte and fluid balance should be monitored daily.[63][74]
If the patient can take fluids orally, encourage them to do so. Otherwise, start intravenous fluids such as lactated Ringer's solution or 0.9% sodium chloride to hydrate the patient.
If the patient has 15% to 20% total body surface area (TBSA) or more of sloughed skin, give them burn resuscitation fluids of: 2-4 mL lactated Ringer's solution × kg weight × % TBSA for adults and children >14 years old, >40 kg; 3 mL lactated Ringer's solution x kg weight x % TBSA for children <14 years old, <40 kg; and dextrose 5% in lactated Ringer's solution for infants <10 kg.
Give 50% of the calculated fluid in the first 8 hours and divide the rest over the next 16 hours.
Regardless of the calculated quantity of fluid for the patient, the clinical evaluation of patient response is extremely important.
Fluid resuscitation is monitored by urine output. It is important that an adult has a urine output of 0.5 mL/kg/hour (30-50 mL/hour) and children weighing <30 kg have an output of 1 mL/kg/hour. Increase or decrease fluid resuscitation based on the urine output.[63][74]
Consult a dermatologist for diagnosis and recommendations.
This complication is rare but may occur on the extremities or torso.[107]
Loss of skin surface exposes the dermis and increases the risk of infection. Monitor vital signs and provide intravenous fluids. Keep the oropharynx and chapped lips as clean as possible.
Do not use adhesive bandages on the exposed skin surfaces.
Take blood and open skin surface cultures and give treatment according to laboratory sensitivities.
If the sloughed skin area is infected, debridement, cleansing the area, antimicrobial therapy, and dressing changes are indicated.[63]
Provide intubation and ventilator support if indicated. Monitor chest x-rays for information on the healing process.
Ocular complications include pseudomembranous conjunctivitis, tear duct loss, corneal ulcerations, anterior uveitis, dacryocystocele, ectropion, trichiasis, and symblepharon.
In Brazilian people of Pardo and European ancestry with SJS/TEN, human leukocyte antigen (HLA)-A*66:01 may be associated with severe ocular complications; HLA-B*44:03 and HLA-C*12:03 may be markers for these complications in European descendants.[101]
Consult an ophthalmologist for diagnosis and recommendations.
Protect nail beds until the nail plates regenerate.
Renal insults occur, leading to acute tubular necrosis and renal failure either as a result of hypoperfusion or due to the pharmaceutical agents, such as antibiotics, that the patients require, especially when they become septic.
Monitor urea and creatinine to determine whether the patient is recovering and take a renal biopsy if indicated, based on patient progress during hospitalisation.[42][44][103]
With the loss of 15% to 20% or more total body surface area through sloughing of the skin, patients lose their skin surface thermoregulatory capability. They become hypothermic and require external warming. Hypothermia is detrimental to their circulatory system, coagulation system, and wound healing. Warming can be achieved by increasing the ambient temperature and by using inflatable plastic blankets filled with warm air.
Hospitalised female patients should be seen by a gynaecologist and receive supportive care to reduce the risk of urogenital complications. They should have a pelvic examination to rule out vaginal synechiae within a few months of hospital discharge. Untreated, vaginal synechiae can impair sexual intercourse or normal vaginal delivery.[2][104]
There have been approximately 13-16 cases reported of chronic pulmonary complications, which include bronchitis, bronchiolitis obliterans, and bronchiectasis.[105]
This complication is rare.[106]
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