> ## Content Index > Fetch the complete content index at: https://www.theplasticsfella.com/llms.txt > Use this file to discover other available public pages before exploring further. # Chemical Burns: Types, Complications, & Management - URL: https://www.theplasticsfella.com/chemical-burns/ - Published: 2024-05-15T11:49:00.000Z - Updated: 2024-05-16T22:24:24.000Z - Description: The most common chemical burns are acids and alkalis. This article details their mechanisms, clinical features, and management. - Author: PlasticsFella - Tags: Burns #### Summary Card [****Overview**](https://www.theplasticsfella.com/chemical-burns/#overview-of-chemical-burns) There are 4 main groups: acids, burns, organic solvents, and inorganic solvents. [****Features**](https://www.theplasticsfella.com/chemical-burns/#features-of-chemical-burns) The degree of chemical burn is dependent on the chemical, its concentration, and the extent of exposure. [****Complications**](https://www.theplasticsfella.com/chemical-burns/#complications-of-chemical-burns) Each chemical has specific secondary effects. For example, hydrofluoric acid has severe pain, low calcium, and raised potassium. [****Management**](https://www.theplasticsfella.com/chemical-burns/#management-of-chemical-burns) Treat with prompt & constant water irrigation (some exceptions!). After neutralisation, manage similar to a thermal burn. ‌ ‌ --- ## Overview of Chemical Burns ****Key Point** The 4 main groups are acids, burns, organic solvents, and inorganic solvents. Chemical burns can be broadly categorised into 4 main groups: acids, burns, organic solvents, and inorganic solvents. They differ in their pathophysiology, clinical progression, and potential complications. Chemical burns are categorised in the table below. ![This is a labelled table showing the chemicals, mechanisms, clinical features and treatment options for common acid and alkali chemical burns.](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2022/06/Chemical-Burns.png) Summary of Chemical Burns 😎 ****Fun Fact:** hydrofluoric acid has soluble free fluoride ions that bind to calcium ions, which causes soft tissue necrosis & severe hypocalcemia. --- ## Features of Chemical Burns ****Key Point** The degree of a chemical burn is dependent on the type of chemical, the extent of exposure, and first aid management. Each chemical has a specific set of secondary features or complications. The degree of a chemical burn can vary based on the **type of chemical**, the **extent of exposur**e, and any **first aid management**. ### Degree of Burn The degree of chemical burn is dependent upon the following variables: 1. Type and extent of exposure (skin, mucosa, inhalation) 2. Type of chemical agent and its mechanism of action 3. Quantity, strength, or concentration of agent The image below illustrates chemical burns on skin. ![Chemical Burn on Skin](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2022/06/Chemical-Burns-on-SKin.png) Chemical Burn on Skin Unlike thermal burns, chemical burns will continue their tissue destruction until inactivated by a neutralising agent. Because of this, the initial estimation of a [burn depth](https://www.theplasticsfella.com/burn-depth/) and [total body surface](https://www.theplasticsfella.com/total-body-surface-area-in-burns/) area is often inaccurate. --- ## Complications of Chemical Burns ****Key Point** Each chemical has specific secondary effects. For example, hydrofluoric acid has severe pain, low calcium, and raised potassium. Each chemical has its own mechanism of burn. As a result, each chemical can often have a specific set of secondary clinical presentations. This can help guide the type of chemical involved and can also help treat the patient. Below is a visual summary of complications of chemical burns. ![A visual summary labelling the complications and effects of chemical burns on lungs, heart, liver, kindey and electrolytes](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2022/06/Complications-of-Chemical-Burns.png) Complications of Chemical Burns - **Acute pain:** hydrofluoric acid - **Hypocalcaemia:** hydrofluoric acid, phosphorous - **Hypomagnesaemia:** hydrofluoric acid - **Hyperkalaemia:** hydrofluoric acid - **Prolonged Q-T Interval:** hydrofluoric acid - **Hepatorenal injury:** tannic, formic acid, phosphorous, petroleum - **Particles embedded in the skin:** phosphorus - **Inhalation injuries:** ammonia - **Methaemoglobinaemia and hemolysis:** cresol - **Perforated nasal septum:** chromic acid --- ## Management of Chemical Burns ****Key Point** Chemical burns are typically treated with prompt and constant water irrigation (some exceptions!). After neutralisation of the chemical, treat complications and manage similar to a thermal burn. Chemical burns are generally treated with prompt and constant water irrigation with some exceptions. ### General Management 1. Remove causative agent and any contaminated clothing. 2. Constant water irrigation whilst monitoring for pH. 3. Monitor systemic toxicity or complications. 4. Assess for specific injuries: eyes, airway, hair, nails, heart, kidneys. 5. Discuss or contact toxicology experts. 6. Once neutralised, treat similarly to a thermal burn. There are specific exceptions to the "constant irrigation with water". These are: - Sodium, potassium, and lithium may ignite. - Phenol is not water-soluble (apply polyethylene glycol). - Hydrochloric acid + H20 may cause exothermic reactions (neutralise by soap). - Diphoterine binds to acids, alkalis, vesicants, and many more substances. ### Hydrofluoric Acid In addition to the above management, hydrofluoric acid requires neutralisation with calcium gluconate to inactivate free fluoride ions. - **Topical** calcium gluconate burn gel (10% with DMSO). - **Injection** with 10% calcium gluconate (multiple 0.1–0.2 ml via 30G needle). - **Intra-arterial** infusion of calcium gluconate. - **Intravenous** ischaemic retrograde infusion (Biers block). - **Early excision** is sometimes required. ### Secondary Injuries - **GI Tract:** endoscopy and CT may show extra-luminal damage. - **Lungs:** fibre-optic bronchoscopy, bronchodilators. - **Eyes**: ophthalmology referral. --- ## Conclusion Upon completing this article, you will have accomplished the following: ****1\. Chemical Burn Categories:** You've gained insight into the four main categories of chemical burns, including acids, burns, organic solvents, and inorganic solvents, and how they differ in their pathophysiology and clinical progression. ****2\. Burn Severity Factors:** You now understand how the type of chemical, its concentration, and the duration of exposure influence the severity of chemical burns and their initial management. ****3\. Identifying Complications:** You've learned about specific secondary effects and complications associated with different chemicals, crucial for effective emergency response and treatment planning. ****4\. Management Techniques:** You are now familiar with the initial management of chemical burns, including the importance of prompt and constant water irrigation and the exceptions where different treatments are required. ****5\. Treatment Protocols:** You've explored detailed protocols for managing complex cases and the necessary steps for addressing systemic and local injuries caused by chemical exposures.