Chemical Burns

Fred P. Harchelroad, Jr. J. Michael Ballester

Pathophysiology

Gen eral.Appro.ac.h

Specific Chemicals

Acids

Alkalis

Metals

Others

Ajrbag.Mur.ns

OcularBurns

Iatrogenic.. Chemical. Burns Systemic Toxicity

Chapter. .References

Chemical burns occur in the home, industrial, agriculture, and military settings, school and research laboratories, and as a result of civilian assaults, hobby accidents, and other accidents. Chemical burns also occur as a result of innocent application of products for medical purposes and for hair, skin, and nail care.

More than 25,000 products are capable of producing chemical burns. Both occupational exposure and contact with numerous chemicals during daily life contribute to the large number of chemical injuries to the skin. There are no good epidemiologic data on the incidence of toxic cutaneous exposure in the nonoccupational setting. However, about 40 percent of all occupationally related diseases reported concern the skin, and about 25 percent of these are due to chemical burns.

Common household chemical burns are caused by lye (drain cleaners, paint removers, urine sugar reagent test tablets), phenols (deodorizers, sanitizers, disinfectants), sodium hypochlorite (disinfectants, bleaches), methacrylic acid (artificial nail products), and sulfuric acid (toilet bowl cleaners). In industries, chemicals are used for cleaning, tanning, curing, extracting, preserving, soldering, and other functions. The most commonly used industrial acids are tungstic, picric, sulfosalicylic, tannic, formic, sulfuric, acetic, cresylic, trichloroacetic, chromic, hydrochloric, and hydrofluoric. Widely used alkalis are the hydroxide salts of sodium, potassium, ammonium, lithium, barium, and calcium. White phosphorus used in munitions was the most common cause of chemical burns to military personnel during times of armed conflict in the 1960s. White phosphorus is also found in rodenticides, pesticides, and fireworks.

The body sites most often burned by chemicals are the face, eyes, and extremities. Fewer than 5 percent of patients admitted to major burn centers suffer from chemical burns. In general, chemical burn average sizes are small, and the mortality rate is lower than for thermal burns, but wound healing and hospital stay times are higher.

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