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

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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

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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

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Clinical Manifestations-Ingestion

Phase 1

• Onset: min-hrs after ingestion
• Cardiovascular Collapse
  • Hypotension (see Hypotension, [[Hypotension]])
• 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]])

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Clinical Manifestations-Inhalation

Pulmonary Manifestations

• Acute Respiratory Distress Syndrome (ARDS) (see Acute Respiratory Distress Syndrome, [[Acute Respiratory Distress Syndrome]])
• Respiratory Tract Irritation
  • Cough (see Cough, [[Cough]])

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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)

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Prognosis

Skin Contact

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

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References

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