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White Phosphorus Exposure Workup

  • Author: Lisandro Irizarry, MD, MPH, FACEP; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
 
Updated: Aug 11, 2015
 

Laboratory Studies

There is no biomarker that can be used to identify acute poisoning from white phosphorus. However, a basic trauma panel that includes the following should be obtained:

  • Complete blood cell count (CBC)
  • Basic metabolic panel
  • Prothrombin time (PT), activated partial thromboplastin time (aPTT), or both
  • Blood type and crossmatch

In addition, the following should be obtained:

  • Serum calcium, phosphorus, and magnesium levels.
  • Urine phosphate levels
 
 
Contributor Information and Disclosures
Author

Lisandro Irizarry, MD, MPH, FACEP Chair, Department of Emergency Medicine, Wyckoff Heights Medical Center

Lisandro Irizarry, MD, MPH, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

José Eric Díaz-Alcalá, MD, FAAEM, FACMT Medical and Executive Co-Director, Medical Toxicology Consultant, Administración de Servicios Médicos de Puerto Rico, ASEM Poison Control Center; Chief, Emergency Medicine Unit, Medical Toxicology Consultant, VA Caribbean Healthcare System

José Eric Díaz-Alcalá, MD, FAAEM, FACMT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Medical Toxicology

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, Medical Society of the State of New York, National Medical Association, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

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, Society for Academic 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.

References
  1. National Research Council (US) Subcommittee on Military Smokes and Obscurants. White Phosphorous Smoke. Subcommittee on Military Smokes and Obscurants, Committee on Toxicology, Board on Environmental Studies and Toxicology, Commission on Life Sciences, National Research Council. Toxicity of Military Smokes and Obscurants. 1. Washington, D.C.: National Academies Press (US); 1999. 2: 18-44. [Full Text].

  2. Voie ØA, Johnsen A, Strømseng A, Longva KS. Environmental risk assessment of white phosphorus from the use of munitions - a probabilistic approach. Sci Total Environ. 2010 Mar 15. 408(8):1833-41. [Medline].

  3. Skaik S, Abu-Shaban N, Abu-Shaban N, Barbieri M, Barbieri M, Giani U, et al. Metals detected by ICP/MS in wound tissue of war injuries without fragments in Gaza. BMC Int Health Hum Rights. 2010 Jun 25. 10:17. [Medline]. [Full Text].

  4. Berndtson AE, Fagin A, Sen S, Greenhalgh DG, Palmieri TL. White phosphorus burns and arsenic inhalation: a toxic combination. J Burn Care Res. 2014 Mar-Apr. 35(2):e128-31. [Medline].

  5. Frank M, Schmucker U, Nowotny T, Ekkernkamp A, Hinz P. Not all that glistens is gold: civilian white phosphorus burn injuries. Am J Emerg Med. 2008 Oct. 26(8):974.e3-5. [Medline].

  6. 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].

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

  8. Harbison RD. Phosphorus. Harbison RD. Hamilton and Hardy’s Industrial Toxicology. 5th ed. Mosby Yearbook; 1998. 194-7.

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

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

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

  12. Obermer E. Phosphorus burns. Lancet. 1943. 1:202.

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

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

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

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