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Burns, Chemical: Differential Diagnoses & Workup
Updated: Jan 10, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
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.
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References
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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].
Mannan A, Ghani S, Clarke A, Butler PE. Cases of chemical assault worldwide: a literature review. Burns. Mar 2007;33(2):149-54. [Medline].
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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].
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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].
Lin TM, Lee SS, Lai CS, Lin SD. Phenol burn. Burns. Jun 2006;32(4):517-21. [Medline].
Bertolini JC. Hydrofluoric acid: a review of toxicity. J Emerg Med. Mar-Apr 1992;10(2):163-8. [Medline].
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].
Friedman EM, Lovejoy FH. The emergency management of caustic ingestions. Emerg Med Clin North Am. Feb 1984;2(1):77-86. [Medline].
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].
Howell JM. Alkaline ingestions. Ann Emerg Med. Jul 1986;15(7):820-5. [Medline].
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
Differential Diagnoses & Workup: Burns, Chemical