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Burns, Chemical: Differential Diagnoses & Workup

Author: Robert D Cox, MD, PhD, Professor, Department of Emergency Medicine, Associate Professor, Department of Pharmacology and Toxicology, University of Mississippi Medical Center; Medical Director, Mississippi Regional Poison Control Center
Contributor Information and Disclosures

Updated: Jan 10, 2008

Differential Diagnoses

Burns, Ocular
CBRNE - Vesicants, Mustard: Hd, Hn1-3, H
CBRNE - Chemical Decontamination
CBRNE - Vesicants, Organic Arsenicals: L, ED, MD, PD, HL
CBRNE - Chemical Warfare Agents
Hazmat
CBRNE - Incendiary Agents, Magnesium and Thermite
Toxicity, Caustic Ingestions
CBRNE - Incendiary Agents, White Phosphorus

Workup

Laboratory Studies

  • Lab studies depend on the burn type and extent of exposure.
  • Severe burns
    • Electrolytes
    • Creatinine
    • BUN
    • Glucose
    • Urinalysis
    • CBC
    • Creatine phosphokinase
    • Coagulation profile
  • Localized burns - Usually no lab tests required
  • Hydrofluoric acid burns
    • Calcium
    • Magnesium
    • Potassium
  • Ingestions of caustics
    • Hemoglobin/hematocrit
    • Pulse-oximetry or ABG if respiratory symptoms
  • Oxalic acid burns
    • Calcium
  • Chromic acid
    • BUN
    • Creatinine
  • Monofluoroacetic acid burns
    • Electrolytes
    • ABG
  • Phenol
    • Electrolytes
    • CBC
    • Urinalysis
    • Creatinine
    • Liver function tests

Imaging Studies

  • Ingestions
    • Chest radiography if any respiratory symptoms
    • Abdominal radiography (flat and upright) if signs of peritonitis are present

Other Tests

  • Endoscopy for ingestions
    • Perform esophagoscopy and gastroscopy on all patients with symptomatic ingestions and on patients who are asymptomatic but have a history of a significant ingestion of a substance with the potential to cause major injury.5,6
    • Findings on esophagoscopy do not correlate well with physical signs and symptoms. Of patients with esophageal injuries, 2-15% have no oral burns.
    • Burn findings are classified as superficial, transmucosal, or transmural.
    • Esophagoscopy findings are used to guide further treatment. The presence of full-thickness or circumferential burns is associated with future stricture formation.
    • The issue of whether to extend the endoscopic examination past the first site of injury is controversial.

Procedures

  • Endotracheal intubation is required for severe respiratory symptoms. Direct visualization is recommended to assess the degree of injury.

More on Burns, Chemical

Overview: Burns, Chemical
Differential Diagnoses & Workup: Burns, Chemical
Treatment & Medication: Burns, Chemical
Follow-up: Burns, Chemical
References

References

  1. Lai MW, Klein-Schwartz W, Rodgers GC, Abrams JY, Haber DA, Bronstein AC. 2005 Annual Report of the American Association of Poison Control Centers' national poisoning and exposure database. Clin Toxicol (Phila). 2006;44(6-7):803-932. [Medline].

  2. Barillo DJ, Cancio LC, Goodwin CW. Treatment of white phosphorus and other chemical burn injuries at one burn center over a 51-year period. Burns. Aug 2004;30(5):448-52. [Medline].

  3. Mannan A, Ghani S, Clarke A, Butler PE. Cases of chemical assault worldwide: a literature review. Burns. Mar 2007;33(2):149-54. [Medline].

  4. Maguina P, Shah-Khan M, An G, Hanumadass M. Chemical scalp burns after hair highlights. J Burn Care Res. Mar-Apr 2007;28(2):361-3. [Medline].

  5. Ramasamy K, Gumaste VV. Corrosive ingestion in adults. J Clin Gastroenterol. Aug 2003;37(2):119-24. [Medline].

  6. Gorman RL, Khin-Maung-Gyi MT, Klein-Schwartz W, et al. Initial symptoms as predictors of esophageal injury in alkaline corrosive ingestions. Am J Emerg Med. May 1992;10(3):189-94. [Medline].

  7. Leonard LG, Scheulen JJ, Munster AM. Chemical burns: effect of prompt first aid. J Trauma. May 1982;22(5):420-3. [Medline].

  8. Mozingo DW, Smith AA, McManus WF, et al. Chemical burns. J Trauma. May 1988;28(5):642-7. [Medline].

  9. Yano K, Hata Y, Matsuka K. Experimental study on alkaline skin injuries--periodic changes in subcutaneous tissue pH and the effects exerted by washing. Burns. Aug 1993;19(4):320-3. [Medline].

  10. Yano K, Hosokawa K, Kakibuchi M, et al. Effects of washing acid injuries to the skin with water: an experimental study using rats. Burns. Nov 1995;21(7):500-2. [Medline].

  11. Lin TM, Lee SS, Lai CS, Lin SD. Phenol burn. Burns. Jun 2006;32(4):517-21. [Medline].

  12. Bertolini JC. Hydrofluoric acid: a review of toxicity. J Emerg Med. Mar-Apr 1992;10(2):163-8. [Medline].

  13. Cox RD, Osgood KA. Evaluation of intravenous magnesium sulfate for the treatment of hydrofluoric acid burns. J Toxicol Clin Toxicol. 1994;32(2):123-36. [Medline].

  14. Friedman EM, Lovejoy FH. The emergency management of caustic ingestions. Emerg Med Clin North Am. Feb 1984;2(1):77-86. [Medline].

  15. Salzman M, O'Malley RN. Updates on the evaluation and management of caustic exposures. Emerg Med Clin North Am. May 2007;25(2):459-76; abstract x. [Medline].

  16. Howell JM. Alkaline ingestions. Ann Emerg Med. Jul 1986;15(7):820-5. [Medline].

  17. Fulton JA, Hoffman RS. Steroids in second degree caustic burns of the esophagus: a systematic pooled analysis of fifty years of human data: 1956-2006. Clin Toxicol (Phila). May 2007;45(4):402-8. [Medline].

Further Reading

Keywords

acid burns, base burns, corrosive ingestion, caustic burn, caustic chemical burn, esophageal burn, sulfuric acid, nitric acid, hydrofluoric acid, hydrochloric acid, muriatic acid, phosphoric acid, acetic acid, formic acid, chloroacetic acid, monochloroacetic acid, dichloroacetic acid, trichloroacetic acid, phenol, cresol, sodium hydroxide, potassium hydroxide, calcium hydroxide, calcium oxide, lime, ammonia, phosphate, chlorate, white phosphorus, vesicants, chromate, potassium dichromate, chromic acid, peroxides, hydrogen peroxide, bleach, potassium permanganate

Contributor Information and Disclosures

Author

Robert D Cox, MD, PhD, Professor, Department of Emergency Medicine, Associate Professor, Department of Pharmacology and Toxicology, University of Mississippi Medical Center; Medical Director, Mississippi Regional Poison Control Center
Robert D Cox, MD, PhD is a member of the following medical societies: American College of Emergency Physicians and American College of Medical Toxicology
Disclosure: Nothing to disclose.

Medical Editor

Jerry Balentine, DO, Professor of Emergency Medicine, New York College of Osteopathic Medicine; Senior Vice President, Chief Medical Officer, Medical Director, Attending Physician in Department of Emergency Medicine, Saint Barnabas Hospital
Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, ABAT, Director of Pharmacy, Sacred Heart Hospital
John T VanDeVoort, PharmD, ABAT is a member of the following medical societies: American Academy of Clinical Toxicology and American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

Jon Mark Hirshon, MD, MPH, Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine
Jon Mark Hirshon, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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