MS 2 - Prelim ( Chemical Burns, TPN, Refeeding Syndrome, and Nitrogen Balance)

What causes chemical burns?

Acids or bases that come into contact with tissue

What are acids in terms of chemistry?

Proton donors (H+)

What are bases (alkalis) in terms of chemistry?

Proton acceptors (OH-)

What kind of necrosis do acids typically cause?

Coagulation necrosis

What kind of necrosis do bases typically cause?

Liquefaction necrosis

What acid causes liquefaction necrosis?

Hydrofluoric acid

What determines burn severity?

pH concentration contact time volume physical form of agent

Why are solid alkali substances dangerous?

Prolonged contact causes more severe burns

What kind of injury do acid burns cause when diluted?

Thermal and caustic injury due to heat generation

What is sulfuric acid used in?

Toilet or drain cleaners battery fluid

What is nitric acid used for?

Engraving metal refining electroplating fertilizers

What are uses of hydrofluoric acid?

Rust removers tile cleaners glass etching petroleum refining

Where is hydrochloric acid found?

Toilet bowl cleaners metal cleaners swimming pool chemicals

Where is phosphoric acid used?

Rustproofing detergents disinfectants

Where is acetic acid found?

Vinegar hair wave neutralizers

Where is formic acid used?

Glue tanning

What are chloroacetic acids used for?

Chemical labs monochloroacetic is highly corrosive and toxic

Where is phenol (carbolic acid) used?

Disinfectants plastics pharmaceuticals

Where is sodium or potassium hydroxide found?

Drain or oven cleaners Clinitest tablets

Where is calcium hydroxide used?

Mortar plaster

What does calcium oxide do with water?

Generates heat causing burns

What are sodium or calcium hypochlorite used in?

Bleach and pool chlorinators

Where is ammonia found and why is it harmful?

Cleaners hygroscopic and can burn via desiccation and heat

Where are phosphates and silicates used?

Detergents and dishwashing agents

What is white phosphorus used for?

Fireworks and munitions smolders in skin

Why are elemental metals dangerous?

React violently with water causing burns

What in hair coloring can cause burns?

Peroxides or concentrated alkali

How do airbags cause chemical burns?

Form sodium hydroxide on deployment

What are vesicants?

Blister agents like sulfur or nitrogen mustard

What education is needed for chemical burns?

Workplace safety child safety social referral if neglect suspected

What history should be asked for chemical burns?

Agent route time volume co-injury irrigation timing

What should be checked in ingestion cases?

Airway stridor drooling dysphagia

What should be assessed for dermal chemical burns?

Size depth circumferential burns

What is checked in ocular exposure?

Visual acuity scleral or corneal lesions

What labs are ordered for severe burns?

Electrolytes BUN Creatinine Glucose CBC CPK coag profile

What is important to monitor for hydrofluoric acid burns?

Calcium magnesium potassium

What do you check for chromic acid exposure?

BUN Creatinine

What is the first step in prehospital care for burns?

Immediate irrigation and clothing removal

How should eye exposures be treated?

Immediate irrigation with water

What is ED care for chemical burns?

Decontamination pH check airway stabilization

How to manage white phosphorus exposure?

Keep moist with water or petroleum jelly

How to remove phenol?

Use polyethylene glycol or water

What topical antibiotics are used in burns?

Silver sulfadiazine Neosporin erythromycin ophthalmic

What pain meds are used for burns?

Morphine IV Percocet ibuprofen ketoprofen naproxen

Why avoid NSAIDs in GI chemical burns?

They may worsen the condition

What bowel agent may help in burns?

PEG bowel cleansers

What is total parenteral nutrition (TPN)?

Supplying all nutritional needs via a vein bypassing the gut

When is TPN indicated?

Obstruction malabsorption GI fistula bowel rest gastroparesis

What are mechanical complications of TPN?

Thrombosis hemothorax pneumothorax air embolism nerve damage

What is a major infectious risk with TPN?

Contamination from container to catheter tip

How to prevent TPN infections?

Aseptic technique regular dressing change filters no meds mixed

How often change TPN tubing?

Every 48 hours

What filter is used for TPN without fats?

0.22 μm filter

What dressing protocol is used for TPN lines?

Sterile sponge occlusive antimicrobial under final dressing

What are early metabolic complications of TPN?

Volume overload hyperglycemia refeeding syndrome electrolyte shifts

What are late complications of TPN?

Fatty acid or vitamin deficiency hepatic cholestasis metabolic bone disease

What is refeeding syndrome?

Electrolyte shifts (low K Mg P) during refeeding of malnourished patients

What are risks of refeeding syndrome?

Dysrhythmia HF respiratory failure coma paralysis

What causes refeeding syndrome?

Switch from fat to carb metabolism causes insulin surge and electrolyte shifts

What is the prevention rule for refeeding?

Start low and go slow

Who are high-risk patients for refeeding?

Anorexia kwashiorkor fasting alcoholism stress IV-only nutrition

What is nitrogen balance?

Measure of net change in body protein

How is nitrogen related to protein?

1 g nitrogen equals 6.25 g protein

What is neutral nitrogen balance?

+0.5 g per day in healthy adults

What states cause positive nitrogen balance?

Anabolism growth pregnancy recovery

What states cause negative nitrogen balance?

Catabolism starvation trauma surgery

How is nitrogen balance measured?

Urinary urea nitrogen plus dietary nitrogen over 24 hours