Chemical Burns

Strong acids
  • Ex. sulfuric, nitric, hydrochloric, chromic
  • Coagulate skin proteins → form a barrier that impedes further penetration
  • Hydrofluoric acid causes liquefactive necrosis → penetration (even down to the bone) may last several days after injury
    • R/ intralesional calcium gluconate
  • If >1% BSA → risk of systemic toxicity
 
Strong alkalis
  • Sodium, calcium, potassium hydroxides, wet cement, sodium and potassium cyanides
  • Degradation of lipids → saponification of the remaining fatty acids → forms soaps which aid the penetration of alkalis deeper into the skin
  • Damage more severe than acids
 
Organic and inorganic chemicals
  • Ex dichromates, arsenates, phenolic compounds
  • Nerve damage → anesthesia
  • Vasoconstriction → necrosis
  • Systemic absorption → shock and renal damage
 
 
 
Treatment
  • Irrigation with large volumes of water
  • Antidotes
    • Calcium gluconate gel for hydrofluoric acid
  • Debridement if risk of systemic toxicity