White phosphorus toxicity: Difference between revisions
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==Background== | ==Background== | ||
*White phosphorus is classically among only 2 chemical burns (other is | *White phosphorus is classically among only 2 chemical burns (other is [[Hydrofluoric acid]]) that required an antidote | ||
*Incendiary agent that spontaneously burns in air | **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 | |||
*Usually not seen unless in military (RPG blasts) or pts exposurd to fireworks | *Usually not seen unless in military (RPG blasts) or pts exposurd to fireworks | ||
*Damage due to both chemical and thermal burn | *Damage due to both chemical and thermal burn | ||
==Complications== | ==Complications== | ||
*The lethal dose when white phosphorus is ingested orally is 1 mg 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 | ||
*Hypocalcemia | *[[Hypocalcemia]] | ||
*Hypophosphatemia | *[[Hypophosphatemia]] | ||
*Hepatic necrosis | *Hepatic necrosis | ||
*Death may occur from burns of only 10-15% TBSA | *Death may occur from burns of only 10-15% total body surface area (TBSA) | ||
==Differential Diagnosis== | |||
*[[Burns|Thermal Burns]] | |||
*[[Acute Respiratory Distress Syndrome]] | |||
*[[Chemical Burns (Eye)|Chemical Burns]] | |||
*[[Hydrofluoric acid]] | |||
==Management== | ==Management== | ||
*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)<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 | *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 | *Monitor Calcium and Phosphorus levels | ||
*Traditionally, copper sulfate used to both convert white | *Traditionally, copper sulfate used to both convert white phospherase and visualize end product (cupric phosphate), but copper is systemically absorbed and may lead to intravascular hemolysis, [[Renal Failure]], and Cardiovascular collapse | ||
* | *Update [[[Tetanus_(Prophylaxis)|Tetatnus]] | ||
==Sources== | ==Sources== | ||
<references/> | <references/> | ||
[[Category:Derm]] | [[Category:Derm]] | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
Revision as of 22:16, 17 September 2014
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
- Usually not seen unless in military (RPG blasts) or pts exposurd to fireworks
- Damage due to both chemical and thermal burn
Complications
- The lethal dose when white phosphorus is ingested orally is 1 mg per kg of body weight[1][2]
- Particles that penetrate tissue continue to cause caustic damage until debrided
- Hypocalcemia
- Hypophosphatemia
- Hepatic necrosis
- Death may occur from burns of only 10-15% total body surface area (TBSA)
Differential Diagnosis
Management
- 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
- Traditionally, copper sulfate used to both convert white phospherase and visualize end product (cupric phosphate), but copper is systemically absorbed and may lead to intravascular hemolysis, Renal Failure, and Cardiovascular collapse
- Update [[[Tetanus_(Prophylaxis)|Tetatnus]]
Sources
- ↑ 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