Chemical Burns

Chemicals can be of any type and each can cause its own unique burn.  Exposures to chemicals can happen in the workplace as well as in the home environment.  Types of chemicals include the following:
  • Acids
  • Alkali
  • Hydrocarbons
  • Pesticides
  • Household cleaning supplies
The most common type of burns occurs on the face, the hands and on other parts of the extremities.  Chemical burns make up only 4 percent of burns and yet cause about 30 percent of the burn victim fatalities.  These types of burns result in longer hospital stays and greater complications than thermal/fire burns.  Most deaths are due to ingestion of the above toxic substances.
 
How do the burns occur?
 
All burns, regardless of their cause, result in areas of denatured proteins.  When this happens, proteins lose their shape and begin to break apart.  This damages parts of the cell membrane so that fluid leaks out of the cells and the cells die.   Chemicals do this by chemical reactions rather than through heat, although some chemical reactions do generate heat.         
                   
Chemical reactions are rated according to the following characteristics:
  • Concentration of the chemical
  • Duration of skin contact
  • Quantity of chemical agents
  • Amount of penetration of chemicals
  • Mechanism of action
  • Whether the agent is in solid, liquid or gaseous form
Mechanism of Action of Chemical Burns
 
Chemicals can have one or more physical action on the body’s tissue.  These include:
 
  • Oxidation.  When a chemical oxidizes tissue, it gives off toxic byproducts that, in themselves, can damage surrounding tissue.  Examples of oxidizing agents include potassium permanganate, sodium hypochlorite, and peroxide.
  • Reduction.  This process adds hydrogen ions to proteins, altering their shape.  Reducing chemicals include iron in ferrous form, hydrochloric acid, nitric acid and sulfites.
  • Corrosion.  These denature proteins upon contact and form the eschar or leathery, dead area on the skin as well as ulcerations.  Examples include sodium metal, phenols, cresols, hydrochloric acid and sulfuric acid.
  • Desiccants.  These dehydrate tissues and cause heat-related accidents, drawing heat into the tissue.  These include sulfuric acid, calcium sulfate, silica gel and muriatic acid.  It is the heat that helps dry out and damage tissue in thermal ways.
  • Vesicants. These produce an immediate lack of blood perfusion to the area with tissue death on contact.  These include DMSO, mustard gas, and Lewisite.
  • Protoplasmic agents.  These bind organic acids and calcium needed for tissue survival and functioning.   Agents include acetic acid, formic acid, oxalic acid, hydrofluoric acid and hydrazoic acid.
Most chemical burns can be divided into acidic or alkali burns.  Strong acids have a pH of 2 or less.  Strong alkali agents have a pH of greater than 11.5.  Alkali burns tend to be more serious because they do not coagulate tissues but instead “melt” tissue.  These melting tissues tend to go deeper within the body than acid burns.  Organic solutions dissolve the lipid membrane of the cell walls, killing cells rapidly.

Managing Chemical Burns

The first step in treating chemical burns is to remove as much of the chemical as possible.   Solid chemicals should be brushed off before flushing with water.  Remove all contaminated clothing and irrigate the wounded area with copious amounts of room temperature water.  Don’t treat a burn with chemicals or by soaking in a tub.  Tub soaking only serves to spread the burn to other body areas.    It may be necessary to irrigate the wound from 30 minutes to up to two hours.  If you have access to a pH strip, you can measure the pH of fluid coming off the irrigated area.  If the pH is around 7, the irrigation is probably adequate.

MSDS sheets are mandatory for all chemicals in the workplace.  MSDS stands for “Material Safety Data Sheets”.  They give recommendations as to how to treat a burn from the specific chemical and what to expect in terms of danger to the person.

It is not a good idea to use neutralizing agents on acid/alkali burns.  These only cause heat to be produced and a worsened thermal burn.  There are few specific antidotes to chemical burns so pure water is what’s usually recommended.

Even with chemical burns, attention must be paid to having a proper airway, adequate breathing and good circulation throughout the body.  Urine output is measured constantly to make sure the fluid requirements of the burning man are met throughout the resuscitation.  As in fire and scald-related burns, the burn is best treated with early excision and grafting of the burned area.

Treatment of Acid Burns

There are multiple acids in industry and in the home that can cause a burn.  Specific agents include acetic acid, carbolic acid (derived from coal tar) and chromic acid.   Carbolic acid is known to cause denatured proteins and dead tissue along with skin dermatitis and abnormal skin pigmentation.  Carbolic acid is also called phenol; it anesthetizes the burn to such a degree that it might not be detected right away.  If you eat as little as a gram of phenol, it can result in death.  One antidote that might work after irrigation is the use of polyethylene glycol.  Sometimes intravenous sodium bicarbonate can counteract the systemic actions of this agent.

Chromic acid burns are not painful but cause deep ulcerations of the skin or in the airway if inhaled.  It carries systemic effects so as little as a 10 percent body surface area burn can be deadly.  Dimercaprol is used by injection to counteract some of the systemic effects of the acid.  Dialysis can be used to clear the body of the acid if necessary.

Formic acid is used in the tanning industry as well as in glue making.  It creates a deep eschar that does not protect the body from systemic effects.  Some total-body effects include lung problems, kidney failure and breakdown of hemoglobin.  It can cause damage to the pancreas and abdominal pain.

Hydrochloric acid is considered one of the most common acid injuries.  It is usually found in many household and industrial cleaning products.  One of the specific dangers of this acid is the finding of an airway injury from inhaling the fumes.  The lungs can fill with fluid if there is significant inhalation.
 
Hydrofluoric acid is the strongest known acid; it is usually used industrially but can be found in the home.  It acts as a corrosive agent and as a metabolic poison. It causes shifts in things like calcium, magnesium and potassium within the body, some of which can be fatal.  The burns are classified according to the concentration of HF (hydrofluoric acid) in the solution splashed onto the individual.  Some antidotes include subcutaneous calcium gluconate, topical calcium gluconate and intra-arterial injections of calcium carbonate.

Alkali Burns

Alkali burns are frequently full-thickness burns because they create a chemical reaction with lipids and proteins that allow for passage of OH- ions through the tissue.  They are very corrosive in nature and penetrate deep into the tissue.   Because they are often found in household cleaning products, they are frequently used in suicides from airway obstruction.
Cement is naturally calcium oxide before it gets mixed with water.  After that, it becomes calcium hydroxide.  It is best to brush away as much of the dry powder and sand before treating with copious amounts of water.

Metals

Elemental metals such as sodium, lithium, magnesium, aluminum and calcium are used in industrial areas.  The react explosively with water so are best treated using a Class D fire extinguisher or sand.   If mineral oil is available, it can be added to the metal to prevent its oxidation in air.

Other Specific Burns

Other agents that can cause cutaneous and soft tissue burns include hydrocarbons, hypochlorite, alkyl mercuric compounds, and tar-based chemicals.  Chemical warfare agents such as lewisite, mustard gas and nitrogen compounds are not usually found in the home or industry.  The treatment of these burns is similar to that of other chemical agents.  Eyes can be irrigated with water or with a balanced salt solution.  Dimercaprol is a specific chelating agent used as an antidote for lewisite toxicity.

A serious burn is a catastrophe. Anyone who has a serious burn thru the negligence of another should contact an experienced catastrophic injury lawyer.
 
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