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White Phosphorus injure, management

Burns. 2001 Aug;27(5):492-7.

The management of white phosphorus burns.


Phosphorus burns are a rarely encountered chemical burn, typically occurring in battle, industrial accidents, or from fireworks. Death may result even with minimal burn areas. Early recognition of affected areas and adequate resuscitation is crucial. Amongst our 2765 admissions between 1984 and 1998, 326 patients had chemical burns. Seven admissions were the result of phosphorus burns

. Our treatment protocol comprises 1% copper sulfate solution for neutralization and identification of phosphorus particles, copious normal saline irrigation, keeping wounds moist with saline-soaked thick pads even during transportation, prompt debridement of affected areas, porcine skin coverage or skin grafts for acute wound management, as well as intensive monitoring of electrolytes and cardiac function in our burns center. Intravenous calcium gluconate is mandatory for correction of hypocalcemia. Of the seven, one patient died from inhalation injury and the others were scheduled for sequential surgical procedures for functional and cosmetic recovery. Cooling affected areas with tap water or normal saline, prompt removal of phosphorus particles with mechanical debridement, intensive monitoring, and maintenance of electrolyte balance are critical steps in initial management. Fluid resuscitation can be adjusted according to urine output. Early excision and skin autografts summarize our phosphorus burn treatment protocol.


Severe thiamine deficiency causes, beriberi, which is a disorder typically associated with a diet consisting largely of polished rice. It may also occur when refined wheat flour forms a major part of the diet and among alcoholics and food faddists. Thiamine deficiency can develop within 2-3 months of inadequate consumption; it is characterized either by cardiac involvement with oedema or by peripheral neuropathy, with intermediate forms between these two extremes also occurring. Left untreated, thiamine deficiency leads to disability and death. In the past decade, several refugee populations that were wholly dependent on food aid have developed thiamine deficiency.

This document is intended primarily as a basis for ensuring adequate thiamine intake among populations in emergency settings. It reviews strategies for preventing thiamine deficiency among refugees and analyses factors influencing success and failure. Also included are a review of the literature on the epidemiology of thiamine deficiency and its signs and symptoms; thiamine’s properties and functions and the recommended daily allowance; and a discussion of food sources of this vitamin and its stability.

Thiamine deficiency and its prevention and control in major emergencies is the second in an occasional WHO series on the prevention and control of micronutrient deficiencies during emergencies. Reviews concerning scurvy and pellagra are also available.

Fitoterapia. 2015 Apr;102:134-48. doi: 10.1016/j.fitote.2015.02.012. Epub 2015 Feb 27.

A comprehensive scientific overview of Garcinia cambogia.


The fruit rind of Garcinia gummi-gutta, commonly known as Garcinia cambogia (syn.), is extensively used traditionally as a flavourant in fish curries due to its sharp sour taste. Additional ethnobotanical uses include its use as a digestive and a traditional remedy to treat bowel complaints, intestinal parasites and rheumatism. This small fruit, reminiscent of a pumpkin in appearance, is currently most popularly used and widely advertised as a weight-loss supplement. Studies have shown that the extracts as well as (-)-hydroxycitric acid (HCA), a main organic acid component of the fruit rind, exhibited anti-obesity activity including reduced food intake and body fat gain by regulating the serotonin levels related to satiety, increased fat oxidation and decreased de novo lipogenesis. HCA is a potent inhibitor of adenosine triphosphate-citrate lyase, a catalyst for the conversion process of citrate to acetyl-coenzyme A, which plays a key role in fatty acid, cholesterol and triglycerides syntheses. The crude extract or constituents from the plant also exerted hypolipidaemic, antidiabetic, anti-inflammatory, anticancer, anthelmintic, anticholinesterase and hepatoprotective activities in in vitro and in vivo models. Phytochemical studies of various plant parts revealed the presence of mainly xanthones (e.g. carbogiol) and benzophenones (e.g. garcinol) together with organic acids (e.g. HCA) and amino acids (e.g. gamma aminobutyric acid). Currently, a large number of G. cambogia/HCA dietary supplements for weight management are being sold although the possible toxicity associated with the regular use of these supplements has raised concerns. In most cases, complaints have been related to multicomponent formulations and at this stage G. cambogia has not been confirmed as the potentially toxic culprit. This review presents a scientific overview of G. cambogia with reference to relevant botanical aspects, ethnobotanical uses, phytochemistry and biological activity as well as toxicity.

Copyright © 2015 Elsevier B.V. All rights reserved.


Garcinia cambogia; Garcinia gummi-gutta; Hydroxycitric acid; Malabar tamarind; Obesity; Toxicity

[PubMed – indexed for MEDLINE]

Garcinia cambogia.

May 4, 2016

Fassina P, Scherer Adami F, Terezinha Zani V, Kasper Machado IC, Garavaglia J, Quevedo Grave MT, Ramos R, Morelo Dal Bosco S.
Nutr Hosp. 2015 Dec 1;32(6):2400-8. doi: 10.3305/nh.2015.32.6.9587.
Acute hepatitis induced by pure Garcinia cambogia.
Melendez-Rosado J, Snipelisky D, Matcha G, Stancampiano F.
J Clin Gastroenterol. 2015 May-Jun;49(5):449-50. doi: 10.1097/MCG.0000000000000303. No abstract available.
A comprehensive scientific overview of Garcinia cambogia.
Semwal RB, Semwal DK, Vermaak I, Viljoen A.
Fitoterapia. 2015 Apr;102:134-48. doi: 10.1016/j.fitote.2015.02.012. Epub 2015 Feb 27. Review.
Acute necrotizing eosinophilic myocarditis in a patient taking Garcinia cambogia extract successfully treated with high-dose corticosteroids.
Allen SF, Godley RW, Evron JM, Heider A, Nicklas JM, Thomas MP.
Can J Cardiol. 2014 Dec;30(12):1732.e13-5. doi: 10.1016/j.cjca.2014.08.025. Epub 2014 Aug 28.
Determination of toxic metals by ICP-MS in Asiatic and European medicinal plants and dietary supplements.Filipiak-Szok A, Kurzawa M, Szłyk E.J Trace Elem Med Biol. 2015 Apr;30:54-8. doi: 10.1016/j.jtemb.2014.10.008. Epub 2014 Nov 4.
IQP-GC-101 reduces body weight and body fat mass: a randomized, double-blind, placebo-controlled study.
Chong PW, Beah ZM, Grube B, Riede L.
Phytother Res. 2014 Oct;28(10):1520-6. doi: 10.1002/ptr.5158. Epub 2014 May 2.
Serotonin toxicity associated with Garcinia cambogia over-the-counter supplement.
Lopez AM, Kornegay J, Hendrickson RG.
J Med Toxicol. 2014 Dec;10(4):399-401. doi: 10.1007/s13181-014-0390-7. No abstract available.
Hydroxycitric acid does not promote inflammation or liver toxicity.
Clouatre DL, Preuss HG.
World J Gastroenterol. 2013 Nov 28;19(44):8160-2. doi: 10.3748/wjg.v19.i44.8160.
Garcinia Cambogia attenuates diet-induced adiposity but exacerbates hepatic collagen accumulation and inflammation.
Kim YJ, Choi MS, Park YB, Kim SR, Lee MK, Jung UJ.
World J Gastroenterol. 2013 Aug 7;19(29):4689-701. doi: 10.3748/wjg.v19.i29.4689.
A review on botanical species and chemical compounds with appetite suppressing properties for body weight control.
Astell KJ, Mathai ML, Su XQ.
Plant Foods Hum Nutr. 2013 Sep;68(3):213-21. doi: 10.1007/s11130-013-0361-1. Review.
Natural products: a safest approach for obesity.
Vasudeva N, Yadav N, Sharma SK.
Chin J Integr Med. 2012 Jun;18(6):473-80. doi: 10.1007/s11655-012-1120-0. Epub 2012 Jul 22. Review.
Evaluation of the safety and efficacy of hydroxycitric acid or Garcinia cambogia extracts in humans.
Márquez F, Babio N, Bulló M, Salas-Salvadó J.
Crit Rev Food Sci Nutr. 2012;52(7):585-94. doi: 10.1080/10408398.2010.500551. Review.

Effect of dietary Garcinia cambogia extract on serum essential minerals (calcium, phosphorus, magnesium) and trace elements (iron, copper, zinc) in rats fed with high-lipid diet.
Gürsel FE, Ateş A, Bilal T, Altiner A.
Biol Trace Elem Res. 2012 Sep;148(3):378-82. doi: 10.1007/s12011-012-9385-x. Epub 2012 Mar 15.
Dietary agents in the prevention of alcohol-induced hepatotoxicty: preclinical observations.
Shivashankara AR, Azmidah A, Haniadka R, Rai MP, Arora R, Baliga MS.
Food Funct. 2012 Feb;3(2):101-9. doi: 10.1039/c1fo10170f. Epub 2011 Nov 28. Review.
Hepatoxicity associated with weight-loss supplements: a case for better post-marketing surveillance.
Lobb A.
World J Gastroenterol. 2009 Apr 14;15(14):1786-7.
Effects of Garcinia cambogia extract on serum sex hormones in overweight subjects.
Hayamizu K, Tomi H, Kaneko I, Shen M, Soni MG, Yoshino G.
Fitoterapia. 2008 Jun;79(4):255-61. doi: 10.1016/j.fitote.2007.12.003. Epub 2008 Feb 9.
Refuting “Evaluation of the genotoxitocity of (-)-hydroxycitric acid (HCA-SX) isolated from Garcinia Cambogia” by Lee and Lee, Journal of Toxicology and Environmental Health, 70:388-392, 2007.
Lau FC, Bagchi M, Bagchi D.
J Toxicol Environ Health A. 2008;71(5):348-9; author reply 350-1. doi: 10.1080/15287390701738525. No abstract available.
Safety of a Novel Calcium/Potassium Saltof (-)-Hydroxycitric Acid (HCA-SX): II.Developmental Toxicity Study in Rats.
Deshmukh NS, Bagchi M, Yasmin T, Bagchi D.
Toxicol Mech Methods. 2008;18(5):443-51. doi: 10.1080/15376510802055022.
Safety of a Novel Calcium/Potassium Salt of Hydroxycitric Acid (HCA-SX): I. Two-Generation Reproduction Toxicity Study.
Deshmukh NS, Bagchi M, Yasmin T, Bagchi D.
Toxicol Mech Methods. 2008;18(5):433-42. doi: 10.1080/15376510802084030.
An overview of the safety and efficacy of a novel, natural(-)-hydroxycitric acid extract (HCA-SX) for weight management.
Preuss HG, Rao CV, Garis R, Bramble JD, Ohia SE, Bagchi M, Bagchi D.
J Med. 2004;35(1-6):33-48. Review.

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