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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
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Imaging Studies

For ingestions, consider the following:

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

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Procedures

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.

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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, 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.

References
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Caustic oral burns.
Caustic burns of tongue.
 
 
 
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