What is the treatment for chloroform burns?

Treatment of Chloroform Burns

Chloroform burns should be treated as chemical burns with immediate and prolonged water irrigation for at least 60 minutes, followed by standard burn wound care including topical petrolatum-based products and non-adherent dressings. 1

Immediate Management

First Aid and Decontamination

• Remove the patient from the source of chloroform exposure immediately and ensure clinician safety with appropriate personal protective equipment 2
• Begin copious water irrigation immediately and continue for a minimum of 60 minutes - this is the single most important intervention for chemical burns and early application reduces hospital stay and scarring 1, 3
• Remove all contaminated clothing that is not stuck to the skin to prevent continued chemical contact 1
• Remove jewelry from affected areas before swelling occurs 4

Cooling Considerations

• For burns with total body surface area <20% in adults or <10% in children without shock, cooling with water (15-25°C) is appropriate 5
• Monitor for hypothermia during prolonged irrigation, especially in children 4
• Do not apply ice directly to burns as this causes tissue ischemia 4

Wound Care After Irrigation

Topical Treatment

• After thorough irrigation, apply a thin layer of petrolatum (Vaseline) or petrolatum-based antibiotic ointment without sulfonamides (polymyxin B or bacitracin) 4, 6
• Alternative topical agents include medical-grade honey or aloe vera gel 4, 6
• Cover the burn loosely with a clean, non-adherent dressing 4, 6
• Leave burn blisters intact to improve healing and reduce pain 4

Pain Management

• Administer over-the-counter oral analgesics such as acetaminophen or NSAIDs 4, 6
• Consider multimodal analgesia combining both acetaminophen and NSAIDs for significant pain 4, 6
• For severe burns requiring hospitalization, titrated intravenous ketamine can be combined with other analgesics 5

Assessment of Burn Depth and Systemic Toxicity

Critical Evaluation Points

• Assess burn depth carefully - chemical burns are notoriously difficult to assess initially as tissue necrosis can continue despite cessation of exposure 2
• Monitor for systemic toxicity from chloroform absorption, including central nervous system depression, cardiac arrhythmias, and hepatotoxicity 7
• Check baseline liver function tests (AST, ALT, bilirubin) as chloroform causes hepatocellular toxicity through free radical-induced oxidative damage 7
• Assess for ocular chemical contact, which requires immediate ophthalmologic consultation 3
• Evaluate for inhalation injury (difficulty breathing, soot around nose/mouth, singed nasal hairs) 4, 6

Indications for Transfer to Burn Center

Transfer to a specialized burn center is indicated for: 5

• Burns involving the face, hands, feet, or genitalia 4, 6
• Full-thickness burns of any size 8
• Partial-thickness burns >10% total body surface area in adults or >5% in children 4, 6
• Signs of inhalation injury 4, 6
• Evidence of systemic toxicity from chloroform absorption 7
• Circumferential burns requiring potential escharotomy 5

Fluid Resuscitation for Severe Burns

• For adult burn patients with total burned body surface area ≥20% and pediatric patients with ≥10%, administer 20 mL/kg of intravenous balanced crystalloid solution (Ringer's Lactate preferred) within the first hour 5
• Balanced crystalloid solutions are preferred over 0.9% NaCl to reduce risk of hyperchloremia, metabolic acidosis, and acute kidney injury 5

Special Considerations for Chloroform

Systemic Toxicity Management

• Consider intravenous N-acetylcysteine (NAC) if there is evidence of hepatotoxicity or significant systemic absorption, as NAC has been successfully used to treat chloroform-induced liver injury 7
• Monitor liver function tests serially, as peak hepatotoxicity may not occur until several days post-exposure 7
• Provide supportive care for central nervous system depression and cardiac monitoring for arrhythmias 7

Common Pitfalls

• Do not delay irrigation while searching for specific antidotes - copious water irrigation is the mainstay of treatment for chemical burns 3, 2
• Do not underestimate burn depth initially - chemical burns often appear superficial but progress to deeper injury over 24-72 hours 2
• Avoid prolonged cold exposure to large burns as this can cause hypothermia and further tissue injury 4
• Do not assume the absence of immediate symptoms means no systemic toxicity - chloroform hepatotoxicity can be delayed 7