White Phosphorus

Types of Phosphorus

Red Phosphorus

  • Uses
    • Match Tip Production
  • Toxicity: not absorbed and has limited toxicity

White (Yellow) Phosphorus

  • Uses
    • Incendiary in Fireworks/Weapons
    • Rodenticide: formerly used much more widely worldwide for this purpose, although still available (as a 2-5% product)
  • Toxicity: highly toxic
    • Ingestion: typically with suicide attempt
    • Inhalation
    • Skin Contact: following combustion
  • White/Yellow Waxy Solid: spontaneously ignites in air forming phosphorus pentoxide
    • Oxidation: results in yellow flame
    • Formation of Phosphoric Acid: results in white smoke
      • Phosphoric Acid is Corrosive and Contributes to Tissue Damage

Physiology

  • Combined Chemical and Thermal Burns to Skin
    • Particles of White Phosphorus Embedded in Wounds Will Oxidize: resulting in ongoing tissue damage until debrided, removed, or consumed
  • Systemic Toxicity

Clinical Manifestations-Skin Contact

Dermatologic Manifestations

  • Skin Burns (see Burns, [[Burns]])

Gastrointestinal Manifestations

  • Hepatic Necrosis/Fulminant Hepatic Failure (see Fulminant Hepatic Failure, [[Fulminant Hepatic Failure]])
    • Epidemiology: associated with systemic toxicity

Renal Manifestations

  • Hypocalcemia (see Hypocalcemia, [[Hypocalcemia]])
    • Epidemiology: associated with systemic toxicity
    • Clinical: may severe
  • Hypophosphatemia (see Hypophosphatemia, [[Hypophosphatemia]])
    • Epidemiology: associated with systemic toxicity

Clinical Manifestations-Ingestion

Phase 1

  • Onset: min-hrs after ingestion
  • Cardiovascular Collapse
  • Peri-Oral/Mucosal Burns
  • Diarrhea (see Diarrhea, [[Diarrhea]])
    • Phosphorescent Stools (“Smoking Stool Syndrome”)
  • Garlic Odor to Breath
  • Nausea/Vomiting (see Nausea and Vomiting, [[Nausea and Vomiting]])
    • Phosphorescent Vomitus
  • Ventricular Arryhthmias
    • xxx

Phase 2

  • Onset: persists for several weeks after ingestion
    • May Be Absent
  • Latent Period During Which Symptoms Appear to Resolve

Phase 3

  • Onset: several weeks later
  • Acute Kidney Injury (AKI) (see Acute Kidney Injury, [[Acute Kidney Injury]])
  • Cardiac Toxicity
    • xxx
  • Central Nervous System Toxicity
  • Gastrointestinal Toxicity
  • Hepatoxicity/Fulminant Hepatic Failure (see Fulminant Hepatic Failure, [[Fulminant Hepatic Failure]])
  • Hypoglycemia (see Hypoglycemia, [[Hypoglycemia]])

Clinical Manifestations-Inhalation

Pulmonary Manifestations


Treatment

Skin Contact

  • Clothing Removal
  • Copious Water Irrigation of Involved Skin: keep particles of white phosphorus embedded in the skin wet to avoid their reignition
  • Surgical Debridement: usually necessary to remove white phosphorous particles which are embedded in the skin
  • Copper Sulfate: no longer used (due to toxicities: renal failure, cardiovascular collapse, death)

Prognosis

Skin Contact

  • Death May Occur with Burns Involving As Little As 10-15% of the Total Body Surface Area

References

  • xxxx