Magnesium and Thermite Poisoning Clinical Presentation

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 or other events occurring at the time of the injury.
• 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.

Incendiary agents produce predominantly dermatologic and respiratory effects.

Vital signs

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 show 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 if 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]

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

Common

• Sparklers
• Road/maritime flares
• Campfire starters

Industrial

• Welding
• Metal purification

Military

• Thermite grenades
• Flares
• Tracer rounds

Miscellaneous - Terrorist explosives