Ver el código de «White phosphorus toxicity»

==Background==
*White phosphorus is classically among only 2 chemical burns (other is [[Hydrofluoric Acid]]) that required an antidote
**The antidote of copper sulfate is controversial and is not universally recommended
*Incendiary agent that spontaneously burns in air and used during WWI, WWII, Vietnam, Korean wars; most recently in Iraq (OIF)
*Usually not seen unless in military or pts exposed to fireworks
*Damage due to both chemical and thermal burn

==Complications==
*The lethal dose when white phosphorus is ingested orally is 1 mg per kg of body weight<ref>Konjoyan TR.[[http://www.atsdr.cdc.gov/toxprofiles/tp103.pdf White phosphorus burns: case report and literature review]]. Mil Med. Nov 1983;148(11):881-4</ref><ref>Agency for Toxic Substances and Disease Registry (ATSDR). U.S. Department of Health and Human Services, Public Health Service. Toxicological Profile for White Phosphorus. 1997</ref>
*Particles that penetrate tissue continue to cause caustic damage until debrided
*[[Hypocalcemia]]
*[[Hypophosphatemia]]
*Hepatic necrosis
*Death may occur from burns of only 10-15% total body surface area (TBSA)

==Differential Diagnosis==
*[[Burns|Thermal Burns]]
*[[Acute Respiratory Distress Syndrome]]
*[[Chemical Burns (Eye)|Chemical Burns]]
*[[Hydrofluoric Acid]]

==Management==
*ABCs to secure airway especially if there is any sign of oral or facial burns. 
*Remove all O2 tanks and tubing from patient
*As healthcare provider, avoid contact with ignited white phosphorus
*Continuous irrigation and grossly debride (use Wood's lamp if available to fluoresce the white phosphorus)<ref>Karunadasa et Al. White Phosphorus Burns Managed Without Copper Sulfate: Lessons From War. Journal of Burn Care & Research: May/June 2010 - Volume 31 - Issue 3 - p503.</ref>
*Wet dressings that cut off O2 exposure to remaining white phosphorus<ref>Rabinowitch IM. et al. Treatment of Phosphorus Burns : With a note on Acute Phosphorus Poisoning. Can Med Assoc J. 1943 Apr;48(4):291-6</ref>
*Monitor Calcium and Phosphorus levels 
*Traditionally, copper sulfate used to both convert white phosphorus and visualize end product (cupric phosphate), but copper is systemically absorbed and may lead to intravascular hemolysis, [[Renal Failure]], and Cardiovascular collapse
*Update [[Tetanus_(Prophylaxis)|Tetanus]]

==Disposition==
*Transfer the the patient to a burn care center 
==Sources==
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