Chemical Burns

The commonest chemical burns are acids and alkalis. This article details their mechanisms, clinical features and management.
Chemical Burns

✅ Summary Card

Overview of Chemical Burns
There are 4 main groups: acids, burns, organic solvents and inorganic solvents

Features of Chemical Burns
The degree of chemical burn is dependent on the chemical, its concentration and the extent of exposure.

Complications of Chemical Burns
Each chemical has specific secondary effects. For example, hydrofluoric acid has severe pain, low calcium, and raised potassium.

Management of Chemical Burns
Treat with prompt & constant water irrigation (some exceptions!). After neutralisation, manage similar to a thermal burn.

Evidence-based flashcards to improve your active recall.

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Overview of Chemical Burns

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.

This is illustrated 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.
Summary of Chemical Burns

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.

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

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 and total body surface area is often inaccurate.

Complications of Chemical Burns

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.

Here 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
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

Generally speaking, chemical burns are treated with prompt and constant water irrigation (some exceptions!). After neutralisation of the chemical, treat complications and manage similar to a thermal burn.

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 similar 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 gylcol)
  • Hydrochloric acid + H20 may cause exothermic reactions (neutralise by soap)
  • Diphoterine binds to acids, alkalis, vesicants 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


Evidence-based flashcards are designed for active recall & spaced repetition using the Feynman Technique.

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