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Magnesium and Thermite Poisoning Clinical Presentation

  • Author: Jayson Tappan, MD; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
 
Updated: Sep 08, 2015
 

History

The history usually makes the nature of the exposure evident, as the patient or rescuer describes the circumstances leading to exposure to thermite or magnesium incendiaries. In the event that a patient presents with burn injury and is unable to give a history, consider exposure to magnesium, thermite, or other hazardous materials.

Determine if the injury occurred in a closed space. Gather information on other aspects of the incident.

Obtain the patient's relevant medical history. In decision-making, consider diseases (eg, diabetes mellitus, vascular disease) that may affect healing. Determine last meal and known drug allergies.

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Physical

Incendiary agents produce predominantly dermatologic and respiratory effects.

As with all resuscitations, first priority is to maintain and support airway, breathing, and circulation (ABC). Patients with airway burns or significant fume exposure may require endotracheal intubation and ventilatory support. Acute respiratory distress syndrome (ARDS) may develop.[4, 5]

Patients with significant dermal burns require aggressive fluid resuscitation, following a formula, such as the Parkland burn resuscitation guidelines, and require monitoring of urinary output and other vital signs.[4, 5]

Inhalation of magnesium dust or magnesium oxide smoke can produce respiratory irritation with the following potential signs and symptoms:

  • Nasal catarrh
  • Productive cough
  • Pneumonitis, including metal fume fever [6]
  • ARDS
  • Hypoxia and tachypnea
  • Airway burns (eg, edema, charring) or lung burns, with potential airway obstruction
  • Wheezes or crackles on lung examination

Unique features of incendiary metal burns are as follows:

  • Thermite burns can deposit molten iron in tissue resulting in very extensive localized tissue damage. Clinicians should assume that these burns are deep partial- or full-thickness until proven otherwise.
  • Magnesium particles can react with tissue fluid to produce magnesium dihydroxide, which produces an alkali chemical burn in addition to direct thermal effects.
  • Retained magnesium particles in skin may produce a lesion that mimics gas gangrene, with tissue necrosis and intratissue gas bubbles due to hydrogen gas formed from the same reaction.

Ocular examination

Incendiary metals emit intensely bright light in the infra-red, visible, and ultraviolet spectra. Tactical military uses include temporarily night blinding of adversaries. The intense light emitted by incendiary metals in military and industrial settings can cause ultraviolet (UV) keratitis. Staining with fluorescein and examination with a slit lamp will confirm such injuries. The fluorescein staining may reveal diffuse punctuate corneal lesions. These lesions generally have a discrete lower border where the lower lid protected the rest of the cornea. Patients may complain of photophobia, decreased visual acuity, and a foreign body sensation.[7]

The eyes must also be examined to determine whether any significant amount of magnesium dust was deposited on the corneas. This can also be seen with a slit lamp and will determine if any cleaning of the corneas or urgent ophthalmological referral is indicated.[7]

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Causes

While exposure to incendiary metals can occur in many settings, serious burns are most likely to result from industrial or military incidents. Lung injury would most likely occur if a person were trapped in a confined space with one of these burning substances.[8]

Common sources of incendiary metal burns include the following:

  • Sparklers
  • Road/maritime flares
  • Campfire starters

Industrial sources of incendiary metal burns include the following:

See the list below:

  • Welding
  • Metal purification

Military sources of incendiary metal burns include the following:

  • Thermite grenades
  • Flares
  • Tracer rounds

In addition, terrorist explosives are a potential source of such injuries.

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Contributor Information and Disclosures
Author

Jayson Tappan, MD Staff Physician, Department of Emergency Medicine, National Naval Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Robin A C Marshall, MD Core Staff Physician, Assistant Residency Director, Civil Service Advocate, Department of Emergency Medicine, Naval Medical Center Portsmouth; Consulting Staff, Department of Emergency Medicine, Riverside Emergency Physicians, Riverside Regional Medical Center

Robin A C Marshall, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Zygmunt F Dembek, PhD, MPH, MS, LHD Associate Professor, Department of Military and Emergency Medicine, Adjunct Assistant Professor, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine

Zygmunt F Dembek, PhD, MPH, MS, LHD is a member of the following medical societies: American Chemical Society, New York Academy of Sciences

Disclosure: Nothing to disclose.

Additional Contributors

Mark Keim, MD Founder, DisasterDoc, LLC; Adjunct Professor, Emory University Rollins School of Public Health; Adjunct Professor, Harvard Affiliated Disaster Medicine Fellowship

Mark Keim, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Jonathan L Burstein, MD, to the development and writing of this article.

References
  1. Chemical casualties. Smokes, fuels, and incendiary materials. J R Army Med Corps. 2002 Dec. 148(4):395-7. [Medline].

  2. Stewart CE, Sullivan JB, eds. Military munitions and antipersonnel agents. Hazardous Materials Toxicology. 1992. 1007-1008.

  3. Mendelson JA. Some principles of protection against burns from flame and incendiary munitions. J Trauma. 1971 Apr. 11(4):286-94. [Medline].

  4. Marx JA, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia: Mosby Elsevier; 2006.

  5. Tintinalli, et al, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York: McGraw-Hill; 2004.

  6. Kaye P, Young H, O'Sullivan I. Metal fume fever: a case report and review of the literature. Emerg Med J. 2002 May. 19(3):268-9. [Medline].

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

  8. Warden CR. Respiratory agents: irritant gases, riot control agents, incapacitants, and caustics. Crit Care Clin. 2005 Oct. 21(4):719-37, vi. [Medline].

  9. Curreri PW, Asch MJ, Pruitt BA. The treatment of chemical burns: specialized diagnostic, therapeutic, and prognostic considerations. J Trauma. 1970 Aug. 10(8):634-42. [Medline].

  10. US Department of Transportation. Emergency Response Guidebook. 2004.

  11. Schwartz SI, ed. Principles of Surgery. 8th ed. New York: McGraw Hill; 2004.

 
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