White phosphorus toxicity: Difference between revisions
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*Incendiary agent that spontaneously burns in air and used during WWI, WWII, Vietnam, Korean wars; most recently in Iraq (OIF) | *Incendiary agent that spontaneously burns in air and used during WWI, WWII, Vietnam, Korean wars; most recently in Iraq (OIF) | ||
*Usually not seen unless in military or patients exposed to fireworks | *Usually not seen unless in military or patients exposed to fireworks | ||
*Damage due to both chemical and thermal | *Damage due to both [[chemical burns|chemical]] and thermal [[burns]] | ||
*The lethal dose when white phosphorus is ingested orally is 1mg per kg of body weight<ref>Konjoyan TR.[[http://www.atsdr.cdc.gov/toxprofiles/tp103.pdf White phosphorus burns: case report and literature review]]. Mil Med. Nov 1983;148(11):881-4</ref><ref>Agency for Toxic Substances and Disease Registry (ATSDR). U.S. Department of Health and Human Services, Public Health Service. Toxicological Profile for White Phosphorus. 1997</ref> | *The lethal dose when white phosphorus is ingested orally is 1mg per kg of body weight<ref>Konjoyan TR.[[http://www.atsdr.cdc.gov/toxprofiles/tp103.pdf White phosphorus burns: case report and literature review]]. Mil Med. Nov 1983;148(11):881-4</ref><ref>Agency for Toxic Substances and Disease Registry (ATSDR). U.S. Department of Health and Human Services, Public Health Service. Toxicological Profile for White Phosphorus. 1997</ref> | ||
*Particles that penetrate tissue continue to cause caustic damage until debrided | *Particles that penetrate tissue continue to cause caustic damage until debrided | ||
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*[[Hypocalcemia]] | *[[Hypocalcemia]] | ||
*[[Hypophosphatemia]] | *[[Hypophosphatemia]] | ||
*Hepatic necrosis | *[[liver failure|Hepatic necrosis]] | ||
*Death may occur from burns of only 10-15% total body surface area ([[TBSA]]) | *Death may occur from burns of only 10-15% total body surface area ([[TBSA]]) | ||
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==Management== | ==Management== | ||
*ABCs to secure airway especially if there is any sign of oral or facial burns. | *ABCs to secure airway especially if there is any sign of oral or facial burns. | ||
*Remove all O2 tanks and tubing from patient | *Remove all [[O2]] tanks and tubing from patient | ||
*As healthcare provider, avoid contact with ignited white phosphorus | *As healthcare provider, avoid contact with ignited white phosphorus | ||
*Continuous irrigation and grossly debride (use Wood's lamp if available to fluoresce the white phosphorus)<ref>Karunadasa et Al. White Phosphorus Burns Managed Without Copper Sulfate: Lessons From War. Journal of Burn Care & Research: May/June 2010 - Volume 31 - Issue 3 - p503.</ref> | *Continuous irrigation and grossly debride (use Wood's lamp if available to fluoresce the white phosphorus)<ref>Karunadasa et Al. White Phosphorus Burns Managed Without Copper Sulfate: Lessons From War. Journal of Burn Care & Research: May/June 2010 - Volume 31 - Issue 3 - p503.</ref> | ||
*Wet dressings that cut off O2 exposure to remaining white phosphorus<ref>Rabinowitch IM. et al. Treatment of Phosphorus Burns : With a note on Acute Phosphorus Poisoning. Can Med Assoc J. 1943 Apr;48(4):291-6</ref> | *Wet dressings that cut off O2 exposure to remaining white phosphorus<ref>Rabinowitch IM. et al. Treatment of Phosphorus Burns : With a note on Acute Phosphorus Poisoning. Can Med Assoc J. 1943 Apr;48(4):291-6</ref> | ||
*Monitor Calcium and Phosphorus levels | *Monitor Calcium and Phosphorus levels | ||
*Traditionally | *Copper sulfate | ||
**Traditionally used to both convert white phosphorus and visualize end product (cupric phosphate) | |||
**However, is systemically absorbed and may lead to intravascular [[hemolytic anemia|hemolysis]], [[renal Failure]], and [[shock|cardiovascular collapse]] | |||
*Update [[Tetanus_(Prophylaxis)|Tetanus]] | *Update [[Tetanus_(Prophylaxis)|Tetanus]] | ||
Revision as of 20:26, 1 October 2019
Background
- White phosphorus is classically among only 2 chemical burns (other is Hydrofluoric Acid) that required an antidote
- The antidote of copper sulfate is controversial and is not universally recommended
- Incendiary agent that spontaneously burns in air and used during WWI, WWII, Vietnam, Korean wars; most recently in Iraq (OIF)
- Usually not seen unless in military or patients exposed to fireworks
- Damage due to both chemical and thermal burns
- The lethal dose when white phosphorus is ingested orally is 1mg per kg of body weight[1][2]
- Particles that penetrate tissue continue to cause caustic damage until debrided
Clinical Features
- Hypocalcemia
- Hypophosphatemia
- Hepatic necrosis
- Death may occur from burns of only 10-15% total body surface area (TBSA)
Differential Diagnosis
Chemical weapons
- Blister chemical agents (Vesicants)
- Lewisite (L)
- Sulfur mustard (H)
- Phosgene oxime (CX)
- Pulmonary chemical agents (Choking agents)
- Incendiary agents
- Cyanide chemical weapon agents (Blood agents)
- Prussic acid (AKA hydrogen cyanide, hydrocyanic acid, or formonitrile)
- Nerve Agents (organophosphates)
- Acetylcholinesterase inhibitors
- Household and commercial pesticides (diazinon and parathion)
- G-series (sarin, tabun, soman)
- V-series (VX)
- Lacrimating or riot-control agents
- Pepper spray
- Chloroacetophenone
- CS
Evaluation
Management
- ABCs to secure airway especially if there is any sign of oral or facial burns.
- Remove all O2 tanks and tubing from patient
- As healthcare provider, avoid contact with ignited white phosphorus
- Continuous irrigation and grossly debride (use Wood's lamp if available to fluoresce the white phosphorus)[3]
- Wet dressings that cut off O2 exposure to remaining white phosphorus[4]
- Monitor Calcium and Phosphorus levels
- Copper sulfate
- Traditionally used to both convert white phosphorus and visualize end product (cupric phosphate)
- However, is systemically absorbed and may lead to intravascular hemolysis, renal Failure, and cardiovascular collapse
- Update Tetanus
Disposition
- Transfer the the patient to a burn care center
See Also
References
- ↑ Konjoyan TR.[White phosphorus burns: case report and literature review]. Mil Med. Nov 1983;148(11):881-4
- ↑ Agency for Toxic Substances and Disease Registry (ATSDR). U.S. Department of Health and Human Services, Public Health Service. Toxicological Profile for White Phosphorus. 1997
- ↑ Karunadasa et Al. White Phosphorus Burns Managed Without Copper Sulfate: Lessons From War. Journal of Burn Care & Research: May/June 2010 - Volume 31 - Issue 3 - p503.
- ↑ Rabinowitch IM. et al. Treatment of Phosphorus Burns : With a note on Acute Phosphorus Poisoning. Can Med Assoc J. 1943 Apr;48(4):291-6