Damage to tissues, referred to as a burn, can be a consequence of thermal factors, electric current, radioactive rays, and certain chemicals. The alkali burn refers to the category of chemical burns (T26-T28 according to ICD-10).
The main risk factors for burning with alkali are violation of the rules for handling concentrated caustic alkalis (work-related injuries), and when various kinds of strong bases (slaked and quicklime, caustic soda, ammonia) are inadvertently used in everyday life.
From the chemical point of view, the causes of the alkali burn are that when a direct contact and physicochemical interaction of alkali (alkali metal hydroxides Na, Ca, K) with the human skin begins, the reaction begins as a corrosion, that is, the corrosive substance corrodes the tissues.
Pathogenesis alkali chemical burns due to the fact that there is an irreversible alkaline hydrolysis reaction in which the hydroxyl anions alkali (OH - ) digested lipids and ceramides keratin of the stratum corneum, break amide bonds of protein molecules of the epidermis and subcutaneous tissue, causing interstitial fluid absorbance. Complete denaturation of proteins with alkali burn ends when the bases bind serum protein albumins, as a result: the osmotic pressure in the cells is disturbed, jelly-like hydrolysis products (albumins) are formed, damaged skin and soft tissue cells swell and die quickly.
The albumin can dissolve, but can not coagulate, so the alkali burn is quite deep - with a specific moist (colliquated) necrosis. The scab formed on the burn site has a loose structure, which increases the risk of infection of the burn wound many times. According to the doctors-kombustiologov, alkali burns are very dangerous and heal more slowly than other chemical burns.
Symptoms of the alkali burn
The first signs of an alkali burn are a feeling of "soapy" skin (this is a sign of the emulsification of the fatty grease of the epidermis, secreted by the sebaceous glands). Very quickly, irritation and redness occurs in the skin that comes into contact with the chemical.
The longer alkali has acted on the skin, the more intense the symptoms of burns with alkali, like burning and swelling of the skin, numbness or pain.
It should be borne in mind that alkalis diffuse into the tissue, so the pathological process (penetration) spreads, which leads to damage to subcutaneous structures that do not immediately appear on the surface.
If the upper layer of the skin (epidermis) is damaged, a superficial burn (1st degree) is formed, which is manifested by skin flushing, burning and painful sensations.
The clinical symptoms of burns with alkali are increased at the 2nd and 3rd degree, when the contact area of the skin with the chemical substance exceeds 8 cm in diameter and the deeper layers of the dermis, subcutaneous and soft tissues are affected. Bubbles do not exist for a given type of chemical burns, a dirty white loose crust appears on the burned surface, under which necrosis begins with the formation and excretion of pus. Since the burn surface in most cases undergoes bacterial initiation, inflammation develops. This stage or phase is called purulent-necrotic, and at this time, adequate treatment is needed.
Then the stages (phases) come in sequence: cleaning the burn wound from the pus, regenerating the epithelium due to the granulation tissue, scarring the wound.
If alkali has got on the face, then an eye burn can occur with alkali - a very dangerous injury with damage to the cornea, sclera, retina, vitreous, leading to partial or complete loss of vision.
The symptoms with which the eye burns with alkali, there is severe pain in the eye, increased lacrimation and spasm of the eye of the eye (blepharospasm). More information in the article - Chemical eye burns
Diagnostics of the alkali burn
The main diagnosis of an alkali burn is to determine the area of the lesion, which, in fact, is an indication of the severity level of the burn. Usually this level can be determined two days after the burn is received.
If for many patients the diagnosis of "alkali burn" means only external damage to the skin, then for the doctor it is a signal to be ready to prevent the consequences and complications of such burns (shock, intoxication, abscesses, sepsis), and in their development - timely identify and prescribe treatment. Due to the mechanism of development of tissue damage, burns with caustic alkali are severe, and surgical treatment (with deep necrosis) may be required.
In addition, the above-mentioned hydroxyl anions of alkalis cause not only external damage: at high concentrations and prolonged exposure, they can penetrate the blood, increasing its pH. This leads to the development of alkalosis with impaired cardiac and renal function.
But in cases of alkaline eye burns, instrumental diagnostics is used: the eyes are examined by an ophthalmoscope and other examinations are carried out. Ophthalmologists are engaged in this.
in the immediate washing of affected skin with cold running water, which is carried out for at least 15 minutes;
in the treatment of water-soaked places with one of the acidifying solutions: 2% solution of citric or boric acid (for 250 ml of water ½ teaspoon); 1% solution of acetic acid; solution of a mixture of 9% table vinegar with water (in a ratio of 1: 3).
First aid for burns with alkali in powder form should be started with its careful removal from the skin in a dry form, and only then can the affected area be washed with water and acidified solution. Note that dissolution of dry alkali in water triggers its damaging effect on the skin.
If the burn is caused by quicklime, it can not be washed by water in any case. It is necessary to remove alkali by treating the skin with any vegetable oil, followed by a dry sterile wipe.
When exposed to the skin slaked lime, after washing with water several times wash the affected area with sweetened water (a tablespoon of sugar without a slide for 250 ml of water). You can make this lotion with this solution.
Burn the eye with alkali and also need a few minutes to rinse with cold water (only under the jet), after which you should continue washing the eyes with 2% solution of boric or citric acid. In this case, you need to urgently apply to a medical institution.
In mild cases of damage to the upper layer of the skin, treatment of an alkaline burn can be performed using all known Panthenol aerosol, liniment synthomycin, and also spray Oxycyclisol (with antibiotic oxytetracycline and corticosteroid prednisolone), antiseptic drugs in the form of solutions for topical use Dioxysol or Novoimanin.
Dioxysol contains an antibacterial agent, dioxidine and an anesthetic lidocaine. The drug is used not only to fight the infection, but also to stimulate the repair process in the burn wound, for which it processes the damaged area and moistens the dressing - once a day. The procedure may be accompanied by a slight burning, but the prolonged use of this solution can cause a side effect in the form of hives. With problems with the heart (bradycardia), low blood pressure and pregnancy, Dioxysol is contraindicated.
1% spirituous extract of St. John's wort - Novoimanin - helps with suppuration of the burn wound (drying it) and relieves inflammation. To wash the wound or wet the dressing, it must be diluted with water (5 parts 1 part extract).
Both at home and in hospitals, an effective dosage form such as ointment (or gel) is used. Doctors recommend antibiotic ointments Levomekol and Levosin (with levomitsetinom), Streptonitol (with sulfanilamides), Sulfargin (with sulfatiazol of silver), etc. For allergies of any etiology. Full information in the material - Ointment from burns.
And about what methods are used in the treatment of moderate and severe burns, you can learn from a separate publication - Treatment of burns
Applying alternative treatment in the form of compresses and lotions, you should remember about compliance with the rules of antiseptics. Therefore, it is best to use decoctions of medicinal plants, and not the preparations that are prepared without heat treatment (that is, they can become a source of infection of the burn wound).
Recommended alternative treatment with herbs includes decoctions of calendula flowers, St. John's wort, leaves of plantain, cotton throat, sweet clover. Well removes the inflammation of a strong broth of bay leaves (5-6 leaves per cup of boiling water). Herbal decoction is prepared based on a tablespoon of raw materials for 200-250 ml of boiling water (boil for about 10-12 minutes); after insisting the broth, they are washed with burn wounds when changing the dressing (1-2 times a day).
Pus squeezes aloe juice; the juice of celandine dries up (diluted with boiled water 1: 1); helps remove inflammation of essential oil of cedar, eucalyptus, tea tree; accelerates the healing of burns with alkali lotion with juice from leaves and stems of golden mustache (kallisium fragrant), propolis, mummies.
Burns with alkali can lead to deep necrosis of tissues, so the best prevention of this type of traumatic effect is caution in handling chemicals both at work and at home. When dealing with alkalis, you need to wear closed clothing, protect your hands with rubber gloves, and your eyes - with special protective goggles.
The prognosis of a burn depends on the degree of its severity. A minor superficial burn of alkali, as a rule, heals fairly quickly with the help of appropriate treatment. More serious burns require long treatment and leave on the body disfiguring scars, damage the muscle tissue, can limit the mobility of joints in the burn zone.
Last update: 25.06.2018
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Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"
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