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| ==Background==
| | #REDIRECT[[Phosphorus toxicity]] |
| *Two naturally occurring forms: red and white phosphorus
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| *Red is not absorbed well, limited toxicity<ref>Poisoning & Drug Overdose, 7e</ref>
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| **Used in manufacture of [[methamphetamines]] and also found in the illicit [[opioid]] "Krokodil"<ref> Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e</ref>
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| **Toxicity largely due to inadvertent production of white phosphorus or phosphine gas during manufacture
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| *[[White phosphorus]] is VERY toxic
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| **White-yellow waxy substance
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| **Exposure predominantly from use as incendiary munition by armed forces (though occasionally used in manufacture of fertilizers, food additives, and cleaning compounds)
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| **Caustic and cellular poison; ignites spontaneously in air, forms phosphorus pentoxide, which then reacts with water to form phosphoric acid
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| **Damage due to both thermal and chemical burns
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| ==Clinical Features==
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| *Vomit and other secretions may have garlic-like odor
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| *Phosphorus particles may fluoresce under Wood's lamp
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| *Skin/eye contact causes '''severe''', partial to full-thickness dermal/ocular [[chemical burns|chemical]] and thermal [[burns]]
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| *Inhalation: [[cough]], wheeze, pneumonitis, [[pulmonary edema]]
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| *Ingestion: mucus membrane irritation/burns, [[abdominal pain]], [[nausea/vomiting]], [[GI bleeding]], [[diarrhea]] (with smoking stools due to spontaneous combustion on exposure to air!!)<ref>Poisoning & Drug Overdose, 7e</ref>
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| *Systemic effects
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| **[[Headache]], [[delirium]], [[seizures]], [[coma]]
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| **[[Dysrhythmias]]; prolonged QT and QRS, both atrial and ventricular arrhythmias
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| **[[AKI]], [[electrolyte abnormalities]]
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| **[[Hepatotoxicity]]- may be delayed 2-3 days after exposure
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| *Chronic exposure associated with mandibular osteonecrosis ("phossy jaw")
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| *Phosphorus in Krokodil likely contributes to the significant skin, vascular, and muscle damage that earned it the nick name "the flesh-eating drug"<ref>Katselou M, Papoutsis I, Nikolaou P et al.: A "Krokodil" emerges from the murky waters of addiction: abuse trends of an old drug. Life Sci 102: 81, 2014. </ref>
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| ==Differential Diagnosis==
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| {{Heavy metals list}}
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| {{Burn DDX}}
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| {{Caustic burn types}}
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| ==Evaluation==
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| *CMP, UA, [[EKG]], [[CXR]] (if inhalational)
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| *Serum phosphorus level NOT helpful in diagnosing (though may want to monitor if concern for other electrolyte abnormalities)
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| *Consider EGD if concern for GI burns
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| ==Management==
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| *Wear PPE to prevent exposure!
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| *Decontamination
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| **Remove contaminated clothing, wash exposed areas with soap and water
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| **Submersion in water/wet dressings can prevent spontaneous ignition of phosphorus particles
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| **Manually debride/remove remaining phosphorus particles- may need wood's lamp to find
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| **Unclear role of [[charcoal]]/[[whole bowel irrigation]] in ingestion
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| *Supportive/symptomatic management
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| **Inhalation: manage airway (may have significant irritation/edema), give [[oxygen therapy]], [[bronchodilators]], treat [[pulmonary edema]]
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| **Rehydrate if significant GI losses, correct electrolyte abnormalities
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| **Consider EGD if concern for GI burns
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| ==Disposition==
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| ==See Also==
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| *[[White phosphorus]]
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| *[[Chemical weapons]]
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| *[[Caustic burns]]
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| ==External Links==
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| ==References==
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| <references/>
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| [[Category:Toxicology]]
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