White phosphorus toxicity
Background
- White phosphorus is among only 2chemical burns that may require an antidote other than irrigation, though many do not recommend copper sulfate anymore(the other is HF acid)
- Incendiary agent that spontaneously burns in air
- Usually not seen unless in military (RPG blasts) or pts working with fireworks
- Damage due to both chemical and thermal burn
Complications
- Particles that penetrate tissue continue to cause caustic damage until debrided
- Hypocalcemia
- Hypophosphatemia
- Hepatic necrosis
- Death may occur from burns of only 10-15% TBSA
Management
- As healthcare provider, avoid contact with ignited white phosphorus
- Continuous irrigation and grossly debride (use Wood's lamp if available)[1]
- Wet dressings that cut off O2 exposure to remaining white phosphorus
- Monitor Ca and Phos levels
- Traditionally, copper sulfate used to both convert white phos and visualize end product (cupric phosphate), but copper is systemically absorbed and may lead to intravascular hemolysis, AKI, CV collapse
- Tetanus
Sources
UpToDate </references>
- ↑ Karunadasa et Al. White Phosphorus Burns Managed Without Copper Sulfate: Lessons From War. Journal of Burn Care & Research: May/June 2010 - Volume 31 - Issue 3 - p503.