Magnesium and Thermite Poisoning Treatment & Management

Updated: Aug 22, 2019
  • Author: Jayson Tappan, MD; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
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Treatment

Prehospital Care

Remove patients from the burning environment, with appropriate attention to personal safety.

Flush thermite burns with copious amounts of water and brush or debride them to remove contaminating particles.

Initial care for magnesium burn wounds should include removal of all unburned particles by mechanical means, including wound debridement, if needed. If particles are present, do not flush with water until particles have been removed.  If water irrigation is needed for burn treatment or other decontamination, use copious amounts to rapidly flush away residual magnesium before the resulting chemical reaction can cause harm. To stop burning particles that cannot be easily removed, the area can be submersed or coated in mineral oil to stop the oxidizing reaction. [10]

Treat burns with standard thermal burn treatment techniques. Undertake standard support of the ABCs, including intubation and fluid resuscitation if needed. [6, 7, 11]  Cover burned areas with dry, sterile dressings or burn-specific dressings. Avoid large areas of wet dressings due to the risk of hypothermia. Narcotic analgesia may be useful if the patient's hemodynamic status permits.

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Emergency Department Care

Emergency department care comprises the following:

  • Institute airway support [12]

  • Start fluid resuscitation, guided by formulas for similar thermal burns [6, 7]

  • Perform wound debridement to remove residual particles of magnesium or iron if not already performed in prehospital setting

  • Aggressively seek and treat associated traumatic injuries (eg, from blast)

  • Assess and start initial treatment of any ocular injuries [9, 13]

  • Institute analgesia

  • Consider all incendiary burns tetanus prone and administer appropriate tetanus prophylaxis

Transfer patients with thermal burns to a burn center if they meet any of the following burn center criteria [11] :

  • Partial-thickness burns over 20% or more of body surface area

  • Full-thickness burns over 10% or more of body surface area

  • Burns involving hands, feet, eyes, ears, and/or perineum

  • Airway involvement

  • Significant underlying illness

  • Age younger than 1 year or older than 65 years

Inpatient care is identical to care for other thermal burns, and it usually involves topical antibiotics (eg, silver sulfadiazine) and surgical debridement. Skin grafting may be needed; institute life-support measures as necessary.

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Consultations

A burn surgeon or other appropriate surgeon (eg, plastic, trauma) should be involved in care. Consult an ophthalmologist if eye injury has occurred. Continuing critical care expertise may be required if injury severity is high.

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Prevention

Workplace and military instruction in the dangers and correct handling of incendiary metals are the mainstay of prevention for accidental exposure and injury. Similarly, public awareness campaigns targeting firework safety in particular can reduce accidental injury and exposure.

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Long-Term Monitoring

Outpatient care is identical to care for other thermal burns. A physician experienced in burn management usually should provide follow-up care for patients. Treatment may include dressings, topical antibiotics, analgesia, and grafting.

Outpatient care for UV keratitis is cycloplegic drops to reduce ciliary muscle spasm and to reduce pain. Topical antibiotics, drops or ointments should be prescribed, to decrease the chance of secondary infection. Patients should also have close follow-up with an ophthalmologist within 24 hours.

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