What is Chemical Burns?
It’s important for healthcare workers to know about chemical burns caused by exposure to acids (which have a pH of less than 7), alkalis (with a pH of more than 7), and other irritating substances. This knowledge would help them to identify, treat and manage these common injuries.
What Causes Chemical Burns?
Chemical burns are injuries that can occur when someone comes into contact with various chemicals often found around the house, at work, or in the environment. Sometimes the burn injury is quite noticeable, such as when there’s a direct spill, while other times it can be less obvious, particularly with children. These burns can lead to health issues that last for a short time, a long time, or even for a person’s whole life, especially if they are not treated properly. In severe cases, they can lead to an early death, particularly if someone swallows a harmful chemical on purpose.
Here are some common substances that can cause chemical burns:
- Acids: This includes chemicals like sulfuric, nitric, hydrofluoric, hydrochloric, acetic acid, formic, phosphoric, phenols, and chloroacetic acid.
- Bases: Examples of these are sodium and potassium hydroxide, calcium hydroxide, sodium and calcium hypochlorite, ammonia, phosphates, silicates, sodium carbonate, and lithium hydride.
- Oxidants: This category includes household bleaches like chlorites, peroxides, chromates, and magnates.
- Miscellaneous: Other substances that can cause burns include white phosphorus, metals, hair dye, and injuries from airbags.
- Vesicants: A vesicant like mustard gas can also cause burns.
Risk Factors and Frequency for Chemical Burns
Chemical burns are common in curious children who are at the ‘cruiser’ level, meaning they are exploring their surrounding environment. It’s because many homes store harmful chemicals in low, easy-to-reach places – such as under the sink – which a child may explore unknowingly. At the same time, both at home and at work, a person can encounter various chemicals that, upon direct contact, can cause injuries externally or internally. This happens due to a lack of awareness about the substances or because of casual exposure.
Shockingly, in recent years in the UK, there have been numerous cases of violent attacks on women using corrosive chemicals.
Typically, children experience chemical injuries at home, whilst adults mainly have these incidents at the workplace.
Signs and Symptoms of Chemical Burns
Exposure to harmful substances can cause changes in various body tissues. The most common areas affected include the eyes, mouth, skin, esophagus (food pipe), and parts of the digestive system, particularly the stomach and pylorus (part of the stomach that opens to the intestines), as well as the respiratory system. Kids who accidentally swallow these substances are at particular risk, as there can be both immediate and lasting damage, even leading to extensive tissue death. For the eyes, whether the harmful substance is an acid or an alkali, the impact can be severe. Rinsing out the eyes with a lot of water is important, as well as checking the pH level, even though the results may not provide much information.
Testing for Chemical Burns
If you come into contact with a harmful substance, it’s essential to check the area of exposure right away. In cases where you may have swallowed the substance, a specialized camera exam, known as endoscopy, should be performed. For example, if you’re exposed to hydrofluoric acid, doctors will keep an eye on your blood calcium and magnesium levels to prevent harm to your cells.
For other contact cases, regularly checking the exposure area for changes is usually enough.
If the harmful substance has affected the digestive system, an experienced doctor who specializes in this area should observe and recheck the healing progress. For eye-related injuries, follow-ups with an eye specialist are necessary to guide additional treatments.
When the toxic substance is swallowed, especially if there’s a risk it may be absorbed into the body, numerous lab tests, including complete blood count, electrolytes, calcium, magnesium, arterial/venous blood gas, liver and kidney tests, lactic acid level, and sometimes clotting tests, might be necessary. X-rays, particularly of the chest while standing, could be used to find free air in the body, which may indicate a perforation or tear.
If there’s concern about free air in the chest after exposure, a CT scan without contrast may be used. In the past, a visible contrasting agent was used, but should be avoided if a perforation is suspected.
Treatment Options for Chemical Burns
If a person is suspected of swallowing a disc or flat battery, a thorough washing of affected external areas is essential. The best way to inspect internal injuries after swallowing something harmful is through an endoscopy. If there are worries about these harmful materials being ingested, it’s necessary to conduct a radiographic assessment, also known as an X-ray. There’s usually no need for a CT scan and MRI studies are not suitable. An ultrasound can give useful information about the location of the swallowed item, but only if done by a professional.
It’s important to note that certain treatments should not be used after a person swallows something harmful. This includes emetic agents (which make someone vomit) or “neutralizing” agents. This is because these treatments can heighten the risk of breathing in harmful substances, increase damage to tissues from retching, or make the situation worse. Currently, there are no recommendations to use systemic medications like steroids, antibiotics, or treatments that protect against kidney/liver damage.
If a person is exposed to Hydrofluoric (HF) acid, abundant irrigation, and application of a specific paste can be helpful. This paste is often available in workplaces using HF acid frequently or can be made in the emergency department. Some professionals also recommend benzalkonium chloride solution. Using protection for the person delivering the treatment is necessary, in some cases; injections of calcium (preferably gluconate form) have been used in the skin or arteries. The measure of effective treatment is the relief of pain. Monitoring calcium and magnesium levels is crucial. If the acid is swallowed, often due to suicidal behavior, it is likely fatal and may need a gastric lavage or stomach washing. Monitoring heart rhythms and electrolyte levels, including calcium and magnesium, is vital here too.
Disc batteries can leak alkali causing local burns, most commonly in the esophagus. Children are often affected, and these cases would need endoscopic management and X-ray tracking of the battery’s location. Removing the battery as soon as possible is highly recommended. If the battery has already passed into the stomach, it’s suitable to wait while closely monitoring the situation and checking stool for the passage of the battery.
What else can Chemical Burns be?
- Removing harmful chemicals from the body
- Poisons used in warfare
- Specific toxins namely Vesicants, Mustard-Hd, and Hn1-3
- Swallowing harmful or corrosive substances
- Dealing with hazardous materials
- Poisoning due to exposure to Magnesium and Thermite
- Injuries or burns to the eye caused by chemicals
What to expect with Chemical Burns
The recovery prospects for a chemical injury depend on the kind of chemical involved and how severe the injury is. While most small injuries are likely to heal well, larger injuries often don’t heal and can form into scars over time. For instance, hydrofluoric acid burns have often led to the loss of fingers.
Eye injuries caused by chemicals are the most serious. These can result in significant scarring and permanent loss of vision.
Possible Complications When Diagnosed with Chemical Burns
The usual problems after an eye injury include pain and scarring, which could even lead to vision loss. It often requires patients to have several appointments with their doctor. In many instances, skin grafts might be needed to help reduce the scarring.
Common problems after an eye injury:
- Pain
- Scarring
- Vision loss
- Multiple doctor visits
- Potential need for skin grafts
Recovery from Chemical Burns
Apart from first-degree burns, all other burns need some sort of follow-up care. For skin burns, a routine check-up every 2 to 4 days is necessary until the burn starts to heal.
If someone has an eye burn, they should see a doctor within 24 hours. For people with burns in the esophagus, they should undergo another endoscopy within 14 to 21 days to make sure that there hasn’t been any narrowing or blockage formed in the area.
Preventing Chemical Burns
To prevent chemical-related accidents in children, it’s important that parents store all hazardous substances beyond the child’s reach.
If a person has tried to harm themselves using chemicals, it’s crucial they are referred to a mental health professional immediately.
