Can contact with lime in concrete cause chemical burns and what is the treatment?

Cement Burns: Caustic Chemical Injury Requiring Immediate Decontamination

Yes, contact with lime (calcium hydroxide) in wet cement causes chemical burns that can result in full-thickness skin necrosis, and treatment requires immediate irrigation with copious running water for at least 15 minutes followed by appropriate wound care. 1

Mechanism of Injury

Wet cement, ready-mixed concrete, and lime contain calcium hydroxide, which is a caustic alkali substance that causes chemical burns through prolonged skin contact. 2, 3 The extent of injury relates to:

• The concentration and pH of the chemical (cement is highly alkaline)
• Duration of skin exposure
• Depth of penetration into tissue
• Volume of chemical contact 1

Even brief skin contact with wet cement can induce extensive lesions and full-thickness burns in some cases. 3, 4 These injuries are often underestimated and unrecognized, leading to serious morbidity when not promptly treated. 5, 6

Immediate Treatment Protocol

Step 1: Decontamination (Most Critical)

Immediate skin decontamination with running water for at least 15 minutes is the cornerstone of treatment and must begin without delay. 1 The 2024 American Heart Association guidelines emphasize that:

• Irrigation should start immediately after chemical exposure 1
• Patients who received immediate irrigation within 10 minutes with large volumes of water for at least 15 minutes had decreased full-thickness burns, fewer total burns, and shorter hospital stays compared to delayed irrigation 1
• In industrial or severe exposures, immediate irrigation reduced full-thickness burns, hospital days, and delayed complications 1

Step 2: Remove Contaminated Materials

Remove all contaminated clothing, jewelry, and surrounding materials from the exposure area to prevent trapping chemicals against the skin during decontamination. 1 This prevents ongoing chemical contact and allows complete irrigation of affected areas.

Step 3: Dry Chemical Considerations

For dry cement powder, it is reasonable to brush off dry chemical before irrigation with water, as some dry chemicals like sodium hydroxide may react with water. 1 However, this should not significantly delay water irrigation.

Post-Decontamination Wound Care

After thorough irrigation, wound management depends on burn depth:

For Partial-Thickness Burns:

• Clean the wound with tap water, isotonic saline, or antiseptic solution 1, 7
• Apply petrolatum-based antibiotic ointment 7, 8
• Cover with non-adherent dressing 7, 8
• Re-evaluate dressings daily 1, 7

For Full-Thickness Burns:

• Cover with clean, dry, non-adherent dressing 7, 8
• All full-thickness cement burns require immediate medical attention and evaluation by burn surgery 5, 6
• Surgical intervention is often necessary, with median inpatient treatment of 9.8 days and average of 1.4 operations required 6

Pain Management

• Administer over-the-counter pain medications (acetaminophen or NSAIDs) for mild burns 7, 9
• Short-acting opioids and ketamine are most effective for severe burn-induced pain 1, 7
• General anesthesia may be necessary for highly painful injuries or wound care procedures 1, 7

Critical Pitfalls to Avoid

• Do not delay irrigation - even with immediate irrigation, concentrated chemicals may cause significant injury requiring advanced medical care 1
• Do not apply ice directly to burns - this causes further tissue damage 7, 8
• Do not apply butter, oil, or home remedies 7, 8
• Do not use external cooling devices for prolonged periods - risk of hypothermia 1, 7
• Do not routinely administer antibiotic prophylaxis - topical antibiotics should be reserved for infected wounds only 1, 7

When to Activate Emergency Medical Services

Call EMS immediately when the patient has: 1

• Respiratory symptoms or systemic symptoms
• Large chemical exposures
• Burns involving face, hands, feet, or genitals 7, 8
• Partial-thickness burns covering >10% body surface area (>5% in children) 7, 8
• Any full-thickness burns 7, 8

Additional Considerations

Consult regional poison centers for chemical-specific treatment recommendations and duration of irrigation. 1 Safety Data Sheets can provide additional guidance for specific cement products. 1

The frequency of cement burns could be reduced through prominent warning notices on cement packaging and educational materials provided with ready-mixed concrete delivery explaining the risks of kneeling in wet concrete and importance of protective measures. 3