Corrosive Poisons

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Corrosive Poisons
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Definition

• A corrosive poison fixes,destroys and erodes the
  surface with which it comes in contact.

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Classification

• Acids
  Alkalis
• Mineral acids
• Organic acids
• Vegetable acids

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• Mineral acids
• Sulphuric acid
• Nitric acid
• Hydrochloric acid
• Organic acids
• Oxalic acid
• Carbolic acid
• Acetic acid
• Salicylic acid

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• Vegetable acids
• Hydrocyanic acid

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Classification

• Alkalis
• Ammonia
• Calcium hydroxide
• Caustic potash Soda
• Ammonium hydroxide

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Mode of action(Mineral acids alkalis)

• Extraction of water from tissues
• Coagulation of surface proteins
• Conversion of hemoglobin into hematin
• Mainly acts on GIT,to some extent on respiratory
  tract.
• No remote systemic action with exception of shock
• In dilute solutions they act as irritants

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• Mineral acids produce coagulation necrosis
• Alkalis produce liquefaction necrosis

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Signs and Symptoms

• Onset immediate
• Symptoms
• Burning sensations (mouth, throat, esophagus,
  stomach)
• Intense thirst
• Dysphagia, retching
• Hematemesis

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• Vomitus is either acidic or alkaline depending on
  substance swallowed.
• Mouth lips are corroded
• Tongueswollen or shriveled
• Teeth chalky white - Sulphuric acid poisoning
  yellowish - Nitric acid poisoning
• Constipation scanty urine with corrosive acids
• Bloody diarrhea with alkalis

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• Ammonia vapours Congestion, watering of eyes,
  cough, choking.
• Collapse occurs because of suffocation
• Dyspnea edema of glottis
• Cardiovascular shock
• (Cold clammy skin, pale face, dilated pupils,
  rapid pulse sighing respiration)
• Consciousness is usually retained till the end

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CAUSE OF DEATH

• IMMEDIATE
• Shock
• Suffocation edema/spasm of glottis
• Gastric perforation
• DELAYED (quantity of poison small)
• Hypostatic pneumonia
• Esophagial stricture (emaciation and
  malnutrition)
• Secondary infections

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TREATMENT

• Stomach tube and emetics are contraindicated
• However soft stomach tube (levine tubes) can be
  passed within one hour to prevent serious caustic
  burns.

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• ACID POISON Alkaline carbonates bicarbonates -
  contraindicated
• Weak alkalis e.g. calcium and magnesium hydroxide
  along with plenty of water or neutralizing agents
  like milk and egg albumin is given
• ALKALI POISON
• Neutralize poison by giving acids like acetic
  acid,citric acid mixed with large quantity of
  water

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• Morphine to relieve pain
• Ice to relieve thirst
• IV fluids to compensate fluid loss
• Steroids Shock
• To prevent esophageal strictures
• Keep the airway patent
• Tracheostomy Acute edema of glottis
• Poisoning by ammonia vapors give oxygen

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• Keep the patient NPO
• Nutrient substances are given by IV route for
  about a week.
• Try liquids,soft food and finally a regular diet.
• Antibiotics to prevent infection

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POSTMORTEM APPEARANCE

• Depends on
• Quantity
• Strength of acid
• Time the patient survives after intake of acid

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• Corrosion of mucus membranes of lips, mouth,
  throat skin over the chin, angles of mouth
  hands.
• Necrotic areas - brown or black and leathery.
• More marked in cases of sulphuric acid poisoning.
• Tissues - stained yellow in nitric acid
  poisoning.

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• Gastric perforation esp with sulphuric acid
• Irritation of respiratory tract (volatile
  poisons like nitric acid, HCL)

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MEDICO LEGAL ASPECTS

• Attempted Suicides
• Not seen now a days due to use of less painful
  substances like barbiturates, narcotics
  organo-phosphorous compounds.
• For Homicides
• Rarely because of taste, immediate local action
  physical changes it produces in food.

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• Vitriolage
• Throwing of a corrosive on face out of jealousy
  or rage.

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VITRIOLAGE

• Throwing of any corrosive on a person with
  malicious intent.
• These fluids are usually thrown on face for
  destroying vision or causing facial
  disfigurement.
• Results in Grievous Hurt.

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• Sulphuric acid - Commonly used.
• Causes chemical burns
• Burns are painless, penetrating
• Acid devitalizes tissues, predisposes to
  infection.
• Repair is slow
• Scar causes contractures.
• Death may result from shock, toxemia if extensive
  areas are involved

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• Other acids/ chemicals used
• Nitric acid
• Carbolic acid
• Caustic soda
• Caustic potash
• Iodine
• Marking nut juice

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SIGNS AND SYMPTOMS

• Sulphuric acid Brown or black discoloration and
  staining of skin and clothing.
• Nitric acid yellow stain
• Trickle marks
• Red line of demarcation

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TREATMENT

• Wash the corrosive acid with large amount of
  water and soap or dilute solution of sodium or
  potassium bicarbonate.
• Thick paste of magnesium oxide is applied
• Raw surface - covered with antibiotic ointment

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• Eyes Washed with large amount of water and
  irrigated by 1 solution of sodium bicarbonate.
• Eye drops containing steroids and antibiotics are
  helpful

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CHEMICAL BURNS
EFFECT Alkali Acid
Injury Severe Less severe
Necrosis Liquefaction Coagulation
Burns Deep 2nd degree
Edema Marked Mild
Eschar Soft, edematous, translucent Hard
Charring Not seen Seen