Alkali burn

Tissue damage, called a burn, can be a consequence of exposure to thermal factors, electric current, radioactive rays, and some chemicals. An alkali burn is classified as a chemical burn (T26-T28 according to ICD-10).

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Risk factors

The main risk factors for getting an alkali burn are the violation of the rules for handling concentrated caustic alkalis (industrial injuries), as well as when various types of strong bases (slaked and quicklime, caustic soda, ammonia) are carelessly used in everyday life.

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Pathogenesis

From a chemical point of view, the causes of alkali burns are that upon direct contact and physical and chemical interaction of alkalis (alkali metal hydroxides Na, Ca, K) with human skin, a corrosion-type reaction begins, that is, the aggressive substance corrodes tissue.

The pathogenesis of chemical alkali burns is associated with the occurrence of an irreversible reaction of alkaline hydrolysis, during which hydroxyl anions of alkali (OH ⁻ ) break down lipids of ceramides and keratins of the stratum corneum of the skin, break amide bonds of protein molecules of the epidermis and subcutaneous tissue, and cause absorption of interstitial fluid. Complete denaturation of proteins in alkali burns is completed when the bases bind serum proteins albumins, as a result of which: osmotic pressure in cells is disrupted, gelatinous hydrolysis products (albuminates) are formed, damaged skin and soft tissue cells swell and quickly die.

Albuminates can dissolve, but cannot coagulate, so the alkali burn is quite deep - with specific wet (colliquation) necrosis. The scab that forms at the site of the burn has a loose structure, which greatly increases the risk of infection of the burn wound. According to burn specialists, alkali burns are very dangerous and heal more slowly than other chemical burns.

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Symptoms alkali burn

The first signs of an alkali burn are a sensation of "soapy" skin (this is a sign of the ongoing emulsification of the epidermal fat secreted by the sebaceous glands). Very quickly, irritation and redness of the skin that has come into contact with the chemical substance occurs.

The longer the alkali acts on the skin, the more intense the symptoms of an alkali burn become, such as burning and swelling of the skin, numbness or pain.

It should be borne in mind that alkalis diffuse into tissues, which is why the pathological process spreads (penetration), which leads to damage to subcutaneous structures that do not immediately appear on the surface.

When the upper layer of the skin (epidermis) is damaged, a superficial burn (1st degree) is formed, which manifests itself as hyperemia of the skin, burning and painful sensations.

Clinical symptoms of alkali burns intensify at the 2nd and 3rd degree, when the area of skin contact with the chemical exceeds 8 cm in diameter and deeper layers of the dermis, subcutaneous and soft tissues are affected. There are no blisters with this type of chemical burns, a dirty-white loose crust appears on the burned surface, under which necrosis begins with the formation and release of pus. Since the burn surface in most cases is subject to bacterial initiation, inflammation develops. This stage or phase is called purulent-necrotic, and at this time adequate treatment is necessary.

Then the following stages (phases) occur sequentially: cleansing of the burn wound from pus, regeneration of the epithelium due to granulation tissue, scarring of the wound.

If alkali gets on your face, it can cause an alkali burn to your eyes – a very dangerous injury that damages the cornea, sclera, retina, vitreous body, leading to partial or complete loss of vision.

Symptoms of an alkali eye burn include severe pain in the eye, increased lacrimation, and spasm of the periorbital muscles (blepharospasm). More information in the article - Chemical eye burns

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Diagnostics alkali burn

The main diagnostics of an alkali burn is to determine the area of damage, which is essentially an indicator of the severity of the burn. This level can usually be determined two days after the burn.

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 if they develop - to promptly identify and prescribe treatment. Due to the mechanism of tissue damage development, a burn with caustic alkali is considered severe, so surgical treatment may be required (in case of deep necrosis).

In addition, the above-mentioned hydroxyl anions of alkalis cause not only external damage: at high concentrations and long-term exposure, they can penetrate into the blood, increasing its pH. This leads to the development of alkalosis with disruptions in the functioning of the heart and kidneys.

But in cases of alkaline burns of the eyes, instrumental diagnostics are used: the eyes are examined with an ophthalmoscope and other examinations are carried out. Ophthalmologists do this.

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Treatment alkali burn

First aid for alkali burns

First aid for alkali burns consists of:

• in immediate rinsing of the affected areas of the skin with cold running water, which is carried out for at least 15 minutes;
• in treating burnt areas washed with water with one of the acidifying solutions: 2% solution of citric or boric acid (½ teaspoon per 250 ml of water); 1% solution of acetic acid; a 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 begin with its careful removal from the skin in dry form, and only then can the damaged area be washed with water and an acidified solution. Keep in mind that dissolving dry alkali in water starts its damaging effect on the skin.

If the burn is caused by quicklime, you should never wash it with water. You need to remove the alkali by treating the skin with any vegetable oil and then applying a dry sterile napkin.

If slaked lime has affected the skin, after rinsing with water, wash the affected area several times with sweetened water (a level tablespoon of sugar per 250 ml of water). You can make compresses with this solution.

An alkali eye burn should also be rinsed with cold water for several minutes (only under running water), after which you should continue rinsing your eyes with a 2% solution of boric or citric acid. In this case, you should urgently contact a medical institution.

Read also: What to do in case of a chemical burn?

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Treatment of alkali burns in hospital

In mild cases of damage to the upper layer of the skin, treatment of an alkali burn can be carried out using the well-known aerosol Panthenol, liniment synthomycin, as well as spray Oxycyclozole (with the antibiotic oxytetracycline and the corticosteroid prednisolone), antiseptic drugs in the form of solutions for local use Dioxizole or Novoimanin.

Dioxizol contains the antibacterial agent dioxidine and the anesthetic lidocaine. The drug is used not only to combat infection, but also to stimulate reparation processes in a burn wound, for which the damaged area is treated with it and the bandage is moistened - once a day. The procedure may be accompanied by a slight burning sensation, but long-term use of this solution can cause a side effect in the form of urticaria. Dioxizol is contraindicated in case of heart problems (bradycardia), low blood pressure and pregnancy.

1% alcohol extract of St. John's wort - Novoimanin - helps with suppuration of a burn wound (drying it out) and relieves inflammation well. To wash a wound or moisten a bandage, it should be diluted with water (1 part extract to 5 parts).

Both at home and in hospitals, such an effective medicinal form as ointment (or gel) is used. Doctors recommend antibacterial ointments Levomekol and Levosin (with levomycetin), Streptonitol (with sulfonamides), Sulfargin (with silver sulfathiazole), etc. for burns of any etiology. Full information in the material - Ointment for burns.

You can learn about the methods used to treat moderate and severe burns from a separate publication – Burn Treatment

Folk remedies

When using folk remedies in the form of compresses and lotions, you should remember to follow the rules of antisepsis. Therefore, it is best to use decoctions of medicinal plants, and not products that are prepared without heat treatment (that is, they can become a source of infection for a burn wound).

Recommended folk herbal treatment includes decoctions of calendula flowers, St. John's wort, plantain leaves, cinquefoil, and sweet clover. A strong decoction of bay leaf (5-6 leaves per glass of boiling water) relieves inflammation well. Herbal decoctions are prepared at the rate of a tablespoon of raw materials per 200-250 ml of boiling water (boil for about 10-12 minutes); after infusing the decoction, burn wounds are washed with it when changing the bandage (1-2 times a day).

Aloe juice draws out pus well; celandine juice (diluted with boiled water 1:1) dries out a weeping wound; cedar, eucalyptus, and tea tree essential oils help relieve inflammation; lotions with juice from the leaves and stems of golden mustache (fragrant callisia), propolis, and mumiyo speed up the healing of alkali burns.

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Prevention

An alkali burn can lead to deep tissue necrosis, so the best prevention of this type of traumatic impact is caution when 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 glasses.

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Forecast

The prognosis of a burn depends on its severity. Minor superficial alkali burns usually heal fairly quickly with appropriate treatment. More serious burns require long-term treatment and leave disfiguring scars on the body, damage muscle tissue, and may limit the mobility of joints in the burn area.

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