eMedicine Specialties > Emergency Medicine > Warfare - Chemical, Biological, Radiological, Nuclear and Explosives

CBRNE - Incendiary Agents, White Phosphorus: Differential Diagnoses & Workup

Author: Lisandro Irizarry, MD, MPH, FAAEM, Chair, Department of Emergency Medicine, Brooklyn Hospital Center; Assistant Professor, Department of Emergency Medicine, Weill Cornell School of Medicine
Coauthor(s): Mollie V Williams, MD, Assistant Clinical Professor, Fellow in Disaster Preparedness, Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn; Geri M Williams, MD, Staff Physician, Department of Emergency Medicine, Brooklyn Hospital Center; José Eric Díaz-Alcalá, MD, FAAEM,, Consulting Staff in Medicine Service, Division of Emergency Medicine/Medical Toxicology, Veterans Affairs Caribbean Healthcare System; Medical Director, Puerto Rico Poison Control Center, San Juan, Puerto Rico
Contributor Information and Disclosures

Updated: Oct 21, 2009

Differential Diagnoses

Acute Respiratory Distress Syndrome
Burns, Chemical
Burns, Ocular
Burns, Thermal
Dermatitis, Contact
Sunburn

Workup

Laboratory Studies

  • Obtain a basic trauma panel (CBC, basic metabolic panel, prothrombin time and/or activated partial thromboplastin time, type and crossmatch) with the addition of calcium, phosphorus, and magnesium levels.
  • Urine and serum phophate levels should be obtained with the addition of calcium and magnesium levels.
  • There has been no biomarker that could be of utility in identifying acute poisoning.

More on CBRNE - Incendiary Agents, White Phosphorus

Overview: CBRNE - Incendiary Agents, White Phosphorus
Differential Diagnoses & Workup: CBRNE - Incendiary Agents, White Phosphorus
Treatment & Medication: CBRNE - Incendiary Agents, White Phosphorus
Follow-up: CBRNE - Incendiary Agents, White Phosphorus
References

References

  1. Agency for Toxic Substances and Disease Registry (ATSDR). U.S. Department of Health and Human Services, Public Health Service. Toxicological Profile for White Phosphorus. 1997. [Full Text].

  2. Geehr EC, Salluzzo RF. Dermal injuries and burns from hazardous materials. In: Sullivan JB Jr,Krieger GR. Hazardous Materials Toxicology, Clinical Principles of Environmental Health. Williams and Wilkins; 1992:415-424.

  3. Harbison RD. Phosphorus. In: Harbison RD. Hamilton and Hardy's Industrial Toxicology. 5th ed. Mosby Yearbook; 1998:194-7.

  4. Konjoyan TR. White phosphorus burns: case report and literature review. Mil Med. Nov 1983;148(11):881-4. [Medline].

  5. Merrifield RB. The automatic synthesis of proteins. Sci Am. Mar 1968;218(3):56-62 passim. [Medline].

  6. Mozingo DW, Smith AA, McManus WF, Pruitt BA Jr, Mason AD Jr. Chemical burns. J Trauma. May 1988;28(5):642-7. [Medline].

  7. Obermer E. Phosphorus burns. Lancet. 1943;1:202.

  8. Pande TK, Pandey S. White phosphorus poisoning--explosive encounter. J Assoc Physicians India. Mar 2004;52:249-50. [Medline].

  9. Rabinowitch IM. Treatment of phosphorus burns. Can Med Assoc J. 1943;48:291-296.

  10. Summerlin WT, Walder AI, Moncrief JA. White phosphorus burns and massive hemolysis. J Trauma. May 1967;7(3):476-84. [Medline].

Further Reading

Keywords

yellow phosphorus, Willy P, hand grenades, mortar rounds, artillery rounds, smoke bombs, munition igniter, chemical burn, munitions, white phosphorus exposure, white phosphorus burn, incendiary agent

Contributor Information and Disclosures

Author

Lisandro Irizarry, MD, MPH, FAAEM, Chair, Department of Emergency Medicine, Brooklyn Hospital Center; Assistant Professor, Department of Emergency Medicine, Weill Cornell School of Medicine
Lisandro Irizarry, MD, MPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Mollie V Williams, MD, Assistant Clinical Professor, Fellow in Disaster Preparedness, Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn
Mollie V Williams, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Geri M Williams, MD, Staff Physician, Department of Emergency Medicine, Brooklyn Hospital Center
Geri M Williams, MD is a member of the following medical societies: American College of Physicians, American Medical Association, Emergency Medicine Residents Association, Medical Society of the State of New York, and National Medical Association
Disclosure: Nothing to disclose.

José Eric Díaz-Alcalá, MD, FAAEM,, Consulting Staff in Medicine Service, Division of Emergency Medicine/Medical Toxicology, Veterans Affairs Caribbean Healthcare System; Medical Director, Puerto Rico Poison Control Center, San Juan, Puerto Rico
José Eric Díaz-Alcalá, MD, FAAEM, is a member of the following medical societies: American Academy of Emergency Medicine and American College of Medical Toxicology
Disclosure: Nothing to disclose.

Medical Editor

Mark Keim, MD, Senior Science Advisor, Office of the Director, National Center for Environmental Health, Centers for Disease Control and Prevention
Mark Keim, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
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

CME Editor

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

Robert G Darling, MD, FACEP, Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine
Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Association of Military Surgeons of the US
Disclosure: Nothing to disclose.

 
 
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