White phosphorus toxicity

Background

• White phosphorus is classically among only 2 chemical burns (other is HF acid) that required an antidote, though many do not recommend copper sulfate anymore
• Incendiary agent that spontaneously burns in air
• Usually not seen unless in military (RPG blasts) or pts exposurd to fireworks
• Damage due to both chemical and thermal burn

Complications

• Particles that penetrate tissue continue to cause caustic damage until debrided
• Hypocalcemia
• Hypophosphatemia
• Hepatic necrosis
• Death may occur from burns of only 10-15% TBSA

Management

• As healthcare provider, avoid contact with ignited white phosphorus
• Continuous irrigation and grossly debride (use Wood's lamp if available)
• Wet dressings that cut off O2 exposure to remaining white phosphorus
• Monitor Ca and Phos levels
• Traditionally, copper sulfate used to both convert white phos and visualize end product (cupric phosphate), but copper is systemically absorbed and may lead to intravascular hemolysis, AKI, CV collapse
• Tetanus

Sources

UpToDate