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Chemical Burns Workup

  • Author: Robert D Cox, MD, PhD; Chief Editor: Joe Alcock, MD, MS  more...
Updated: Oct 06, 2015

Laboratory Studies

Laboratory studies depend on the burn type and extent of exposure.

For severe burns, consider the following:

  • Electrolytes
  • Creatinine
  • BUN
  • Glucose
  • Urinalysis
  • CBC count
  • Creatine phosphokinase
  • Coagulation profile

For localized burns, usually no laboratory tests are required.

For hydrofluoric acid burns, consider the following:

  • Calcium
  • Magnesium
  • Potassium

For ingestions of caustics, consider the following:

  • Hemoglobin/hematocrit
  • Pulse-oximetry or ABG if respiratory symptoms

For oxalic acid burns, check calcium.

For chromic acid burns, consider the following:

  • BUN
  • Creatinine

For monofluoroacetic acid burns, consider the following:

  • Electrolytes
  • ABG

For phenol burns, consider the following:

  • Electrolytes
  • CBC count
  • Urinalysis
  • Creatinine
  • Liver function tests

Imaging Studies

For ingestions, consider the following:

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

Other Tests

Endoscopy for ingestions is as follows:

  • 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.[11, 12]
  • 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.

Check the pH for any chemical exposure to the eye or for airbag injuries.



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

Bullae resulting from chemical burns should be decompressed and debrided.

Contributor Information and Disclosures

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, American College of Medical Toxicology

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Jon Mark Hirshon, MD, MPH, PhD Professor, Department of Emergency Medicine, University of Maryland School of Medicine

Jon Mark Hirshon, MD, MPH, PhD 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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center

Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Jerry R Balentine, DO, FACEP, FACOEP Vice President, Medical Affairs and Global Health, New York Institute of Technology; Professor of Emergency Medicine, New York Institute of Technology College of Osteopathic Medicine

Jerry R Balentine, DO, FACEP, FACOEP is a member of the following medical societies: American College of Emergency Physicians, New York Academy of Medicine, American College of Osteopathic Emergency Physicians, American Association for Physician Leadership, American Osteopathic Association

Disclosure: Nothing to disclose.

  1. Taira BR, Singer AJ, Thode HC, Lee C. Burns in the Emergency Department: A National Perspective. J Emerg Med. 2010 Jul. 39(1):1-5.

  2. Bronstein AC, Spyker DA, Cantilena LR Jr, Rumack BH, Dart RC. 2011 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). 2012 Nov. 50 (10):911-1164.

  3. 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. 2004 Aug. 30(5):448-52. [Medline].

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

  5. Tahir C, Ibrahim BM, Terna-Yawe EH. Chemical burns from assault: a review of seven cases seen in a Nigerian tertiary institution. Ann Burns Fire Disasters. 2012 Sep 30. 25(3):126-30. [Medline]. [Full Text].

  6. Notes from the field: exposures to discarded sulfur mustard munitions - mid-atlantic and new England States 2004-2012. MMWR Morb Mortal Wkly Rep. 2013 Apr 26. 62(16):315-6. [Medline].

  7. Li W, Wu X, Gao C. Ten-year epidemiological study of chemical burns in Jinshan, Shanghai, PR China. Burns. 2013 Apr 24. [Medline].

  8. Ford JB, Sutter ME, Owen KP, Albertson TE. Volatile Substance Misuse: An Updated Review of Toxicity and Treatment. Clin Rev Allergy Immunol. 2013 May 7. [Medline].

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

  10. Scarlett A, Gee P. Corneal abrasion and alkali burn secondary to automobile air bag inflation. Emerg Med J. 2007 Oct. 24(10):733-4. [Medline].

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

  12. 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. 1992 May. 10(3):189-94. [Medline].

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

  14. Spector J, Fernandez WG. Chemical, thermal, and biological ocular exposures. Emerg Med Clin North Am. 2008 Feb. 26(1):125-36, vii. [Medline].

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

  16. 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. 1993 Aug. 19(4):320-3. [Medline].

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

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

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

  20. 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].

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

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

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

  24. 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). 2007 May. 45(4):402-8. [Medline].

Caustic oral burns.
Caustic burns of tongue.
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