Total body surface area

Du Bois area The total body surface area of a person. 

Dyspnea was reported in pigs treated with a single dose of 500 mg/kg of undiluted phenol over 35-40% of the total body surface area (0.44 mg/cm2/kg) (Pullin et al. 1978). This treatment resulted in the death of two of the three treated pigs. 

Treatment of psoriasis should be limited to once-daily application not to exceed 20% of total body surface area. Adverse local effects include a burning or stinging sensation (sensory irritation) and peeling, erythema, and localized edema of the skin (irritant dermatitis). Potentiation of photosensitizing medication may occur, and patients should be cautioned to minimize sunlight exposure and to use sunscreens and protective clothing. 

Asaria et al. [29] reported a retrospective review of 125 bum patients admitted to a hospital in Kampala, Uganda over an 18-month period in 2001-2002 [29]. Of these, 15 patients (17%) were victims of deliberate acid assault. The male/female ratio was 1 1. The average total body surface area (TBSA) involved was 14.1% and the most common bum sites were the face (86.7%), head and neck (66.7%), chest (53.5%), and upper limbs (60%). The eyes were commonly involved... 

The Department considers the protocols used in the Durham and Wolfe (6) study as quite useful guides however, the percentage of the body reported as exposed in that study is considered as underreported unless impervious clothing is worn. The Department usually considers the skin on the entire body to be subject to some exposure. We use data from two articles as references for determining total body surface area one by Berkow and Amboy ( 7), and another by DuBois and Dubois (j6). ... 

Using the estimate of the amount of pesticide in the air (equation 1) and the total body surface area available for contact, the maximum potential contact for a 70 kg body weight (BW) would be ... 

Tazarotene (Tazorac) is an acetylenic retinoid prodrug that is hydrolyzed to its active form by an esterase. The active metabolite, tazarotenic acid, binds to retinoic acid receptors, resulting in modified gene expression. The precise mechanism of action in psoriasis is unknown but may relate to both anti-inflammatory and antiproliferative actions. Tazarotene is absorbed percutaneously, and teratogenic systemic concentrations may be achieved if applied to more than 20% of total body surface area. Women of childbearing potential must therefore be advised of the risk prior to initiating therapy, and adequate birth control measures must be utilized while on therapy. 

The test chemical or drug should uniformly cover an area (approximately 10% of the total body surface area). With highly toxic chemicals, the surface area covered may be less, but the area should be covered with a thin, uniform film of the test chemical. 

Although burns are cutaneous injuries, the effects can influence nearly all systems of the body. The overall morbidity associated with a burn injury will be determined by burn depth, percentage total body surface area (TBSA) involved, patient age, and presence of inhalation injury. Children and older adults have thinner skin and are more likely to sustain a deeper burn injury. Patients at the age extremes are also less likely to tolerate the stress of burn shock. The presence of an inhalation in-... 

Partial thickness burns greater than 10 % total body surface area (TBSA)... 

An earthquake struck Duzce, Turkey, at 7 p.m. on November 12, 1999, a time when families were preparing dinner, washing their children, and heating their homes (Ad-El, Engelhard, Beer, Dudkevitz, Benedeck, 2001). Consequently, 27 adults and 13 pediatric patients were treated for burn injuries, most of which were deep and deep partial thickness burns to the lower extremities due to hot liquids, usually water, spilled during the quake (Ad-El et al., 2001). Two of the pediatric patients sustained 30% and 40% total body surface area burns and were transferred to a burn unit the remaining patients were treated as outpatients, as the local hospital was destroyed in the earthquake (Ad-El et al., 2001). 

While the decision to evacuate and hospitalize HD casualties is based on the extent [total body surface area (TBSA) > 5%], severity of the skin lesions, and the recognition of multiple organ involvement (Graham et al, 2005), the threshold to hospitahze children with HD injuries should be lower. One reason is that vapor mustard used by terrorists may cause extensive pulmonary involvement while producing mild skin blisters. 

Hakkinen PJ, Kelling CK, and Callender JC (1991) Exposure assessment of consumer products Human body weights and total body surface areas to use, and sources of data for specific products. Veterinary and Human Toxicology 33 61-65. 

In 1990, urine samples from an accidental laboratory exposure to sulfur mustard were obtained (Jakubowski et al., 2000). The erythematous and vesication areas of the individual were estimated to be less than 5% and 1%, respectively, of the total body surface area. The assay measured both free and conjugated TDG using GC-MS (Jakubowski et al., 1990). The maximum TDG urinary excretion rate was 20 (pg/day on day 3. TDG concentrations of 10 ng/mL or greater were observed in some samples for up to a week after the exposure. A first-order elimination was calculated from days 4 through 10 and found to be 1.2 days. A great deal of intraday variability was noted for the TDG urine concentrations. Attempts were made to estimate the total amount of sulfur mustard on the skin of the patient. The estimate was based on two assumptions (1) that the assay for the free and conjugated TDG represents approximately 5% of the total amount of sulfur mustard related products in the blood, and (2) that the bioavailability factor from skin to blood is 10. A total of 0.243 mg of TDG was recovered over a 2 week period. This would represent 4.86 mg in the blood or 48.6 mg on the skin. 

Critically ill, hypermetabolic 30 to 35 kcal/kg per day Major burn injury (>50% total body surface area) 35 to 40 kcal/kg per day... 

Several case reports described exposure of individuals to ammonia liquid and/or gas that resulted in cutaneous bums (Amshel et al. 2000 da Fonseca et al. 1998 George et al. 2000 Kerstein et al. 2001 Latenser and Lucktong 2000 Leduc et al. 1992 Rosenbaum et al. 1998 Weiser and Mackenroth 1989). All exposures were occupationally related. Total body surface area burned ranged from 14 to 45% and most had at least small areas of fiill-thickness bums that required skin grafting. A summary of 12 case reports of liquid anhydrous ammonia injuries reported a range of percent body surface area burned of... 

This chapter also introduces the geometric length A, called the diffusion length, and shows that this physical length scale is closely related to the square root of the total body surface area when the body is convex. 

Preparation of skin Approximately twenty-four hours before testing, fur from the back of animals should be clipped so that no less than 10% (about 240 cm ) of the total body surface area is available for application of material. 

Nebulized 2.5% calcium gluconate has been reported for cases of inhala-tional HF exposure. Inhalational exposure should be considered with dermal exposures of >5% total body surface area. 

A 56-year-old man with hypertension suffered a 62% total body surface area burn (day 0) and on day 4 developed atrial fibrillation with a rapid ventricular rate, which was treated with amiodarone and digoxin. After pyloroplasty for a bleeding ulcer on day 20, he developed a postoperative ileus and was given metoclopramide 20 mg intravenously every 6 hours. Beginning on day 54, he started to have episodes of bradycardia and asystole. Some episodes required atropine and others resolved spontaneously. Some converted initially to a junctional rhythm, but all ultimately reverted to sinus tachycardia. Digoxin and metoclopramide were withdrawn and several hours later the bradydysrhythmias stopped. 

Peck MD, Kessler M, Meyer AA, Bonham Morris PA. A trial of the effectiveness of artificial dermis in the treatment of patients with bums greater than 45% total body surface area. J Trauma 2002 52 971-8. 

Fig. 2.14 Toxic epidermal necrolysis in an adult patient covering more than 30 % of the total body surface area. From Struck MF et al. Severe cutaneous adverse reac-...

Literature gives another table for lethal risk, depending on the concentration and route of exposure. TBSA in Fig. 4.31 means total body surface area. 

TBSA (total body surface area) deep bums to his bilateral lower limbs, hands, and back. The lower extremity injuries were severe, and on the left lower limb had penetrated through the fascia and muscle. An above-the-knee amputation was necessary for the left lower extremity injury and a fasciotomy was required for the right lower extremity injury. ICU admission was necessary for 8 days, as weU as frequent returns to the operating room for dressing changes and skin grafting. The clinical course was complicated by atrial fibrillation and sepsis. The total hospital stay was 114 days, followed by outpatient rehabilitation [212]. 

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