Chemical Mediator in a Spilled Hot Water Burn
Histamine is the primary chemical mediator in a scald burn (hot water burn), triggering the immediate inflammatory cascade characterized by vasodilation and increased microvascular permeability. 1
Pathophysiology of Burn Injury Mediators
The inflammatory response in scald burns follows a specific sequence:
- Initial mediator release: Histamine is the earliest chemical mediator released following thermal injury 1, 2
- Secondary mediator cascade: Following histamine release, other mediators are subsequently activated, including:
Mechanism of Action
Histamine's role in burn injury involves:
- Immediate vasodilation
- Increased microvascular permeability
- Initiation of the inflammatory cascade 1, 2
The earliest stage of vasodilatation and increased venous permeability is commonly attributed to histamine release from damaged tissue and mast cells 2. This leads to the characteristic edema formation seen in burn injuries.
Clinical Implications
Understanding histamine as the primary mediator has important clinical implications:
- Immediate cooling: Helps limit the histamine-mediated inflammatory response 1
- Fluid management: The histamine-triggered increase in vascular permeability necessitates appropriate fluid resuscitation in severe burns 1
- Pain management: The histamine-initiated cascade contributes significantly to burn pain, requiring multimodal analgesia 1
Answer to Multiple Choice Question
Based on the most recent and highest quality evidence, the answer is:
A. Serotonin - Incorrect (secondary mediator)
B. Bradykinins - Incorrect (secondary mediator)
C. Thromboxane - Incorrect (secondary mediator)
D. Prostaglandins - Incorrect (secondary mediator)
The correct answer would be histamine, which is not listed among the options. Of the choices provided, none represent the primary initial mediator in a spilled hot water burn.