injuries poisoning
Incendiary Chemical Warfare Agents and Hydrogen Fluoride (HF)
Pathophysiology
Incendiary agents cause thermal burns. Some of them may be used in exploding projectiles which cause shrapnel that may lodge in tissue. White phosphorus may continue to burn on skin or clothing as long as it has access to air, and because magnesium will burn under water, it will continue to burn within tissue. White phosphorus is toxic and may also cause systemic effects, due to uncoupling of oxidative phosphorylation in hepatocytes, hyperphosphatemia, hypocalcemia (from binding of calcium to phosphorus), renal injury, and hyperkalemia (from hypocalcemia or from renal damage). HF penetrates deeply and quickly into exposed tissue but generates hydronium ions relatively slowly. The fluoride released from the dissociation of hydrogen fluoride binds avidly to calcium and magnesium. This binding, particularly the binding to calcium, produces severe local pain and may produce systemic effects due to hypocalcemia, hypomagnesemia, and hyperkalemia; coagulopathy and fatal cardiac arrhythmias may occur. 