White phosphorus toxicity

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  • 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 burn
  • 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

Differential Diagnosis

Chemical weapons



  • 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
  • Traditionally, copper sulfate used to both convert white phosphorus and visualize end product (cupric phosphate), but copper is systemically absorbed and may lead to intravascular hemolysis, Renal Failure, and Cardiovascular collapse
  • Update Tetanus


  • Transfer the the patient to a burn care center

See Also


  1. Konjoyan TR.[White phosphorus burns: case report and literature review]. Mil Med. Nov 1983;148(11):881-4
  2. 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
  3. 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.
  4. 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