Chemical Burns in Emergency Medicine Workup

  • Author: Robert D Cox, MD, PhD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jun 28, 2010
 

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
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Imaging Studies

  • Ingestions
    • 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
    • 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.[7, 8]
    • 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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Proceed to Treatment & Management
 
 
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.

Specialty Editor Board

Jerry Balentine, DO  Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St 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.

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  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.

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

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

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  2. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). Dec 2008;46(10):927-1057. [Medline].

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  16. 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].

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

  20. 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].

 
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Caustic oral burns.
Caustic burns of tongue.
 
 
 
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