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Acid poisoning/ingestion

Treatment:
1) Avoid
- gastric lavage
due to risk
of gastric distention
- emetics
(liberation
of CO2), rupture &
- carbonated (gaseous drinks)
perforation
- alkaline carbonates / bicarbonates
- oral feed until endoscopy confirms extent of injury
- weak bases/dilute alkalizers like milk of magnesia or lime water (i.e.
calcium hydroxide in water as exothermic rxn extend the corrosive injury
- strong alkali / alkalies like sodium bicarbonate as it produces CO2
increasing risk of gastric perforation
2) Give
- demulcents: milk (canned condensed milk), egg white (beaten), vegetable
oils (olive oil, mineral oil), melted butter , starch solution or starch water,
barley water, thin gruel, etc (prevent systemic absorption by coating,
neutralize acid)
- dilution by litre water or milk though tissue injury occurs rapidly within
30 mins of ingestion
- Correction of shock (circulatory collapse): prednisolone 60 mg/day may
be given in divided doses to prevent esophageal stricture & shock ; later
pass 4cm diameter mercury-filled bougie daily if stricture develops; IV
fluids & electrolytes, nutrients in I.V. drip /route for a week & later liquids,
soft food & then finally a regular diet
- symptomatic: antibiotics for control of infection; morphine/pethidine for
symptomatic relief of pain
- airway maintenance & artificial respiration if there any respiratory
distress; Tracheostomy If oedema of glottis
- Skin burns to be washed with copious amount of water or saline irrigation
and sodium bicarb or mgo2 paste to be applied; treat with nonadherent
gauze & wrapping, topical silver sulfadiazine in deep 2 nd degree burns
- Eye burns to be irrigated with water or NAHCO3 soln for 10-15 mins; a
suspended i.v. bag that administers low pressure irrigation is ideal;
retraction of eyelids & copious irrigation for 20-30 mins; antibiotic eye
drop to prevent infection; referral to ophthalmologist for further t/t is
prudent
- Despite all the efforts, patients do die & the two main causes of death in
any acid poisoning:
Immediate
-shock due to circulatory collapse or
collapse due to perforation of

Delayed
-hypostatic pneumonia

stomach
-suffocation or asphyxia due to
spasm or oedema of glottis
-exhaustion
-toxaemia
FD: 10-15 ml (for all acids as per VPG
sir)

-secondary infection or peritonitis


-renal failure
-starvation & dehydration due to
stricture of oesophagus or pylorus
FP: 18-24 hr (for all acids as per VPG
sir)

Signs and symptoms of inorganic acid poisoning (except HF ACID) but vary in
intensity depending on the type & concentration of acid
- in respiratory tract/respiratory S/S:
Inflammatory edema of larynx/glottis------Dyspnea-------Suffocation--------DEATH
- in GIT/gastrointestinal S/S:
a) severe burns in mouth, oesophagus, stomach:
i)
dysarthria, dysphagia, retching, vomiting,
haematemesis, severe pain, dehydration, starvation &
thirst
ii)
perforation of stomach----chemical peritonitis
iii)
stricture of esophagus, pylorus on recovery-----dysphagia infection

SHOCK & DEATH


-

others:
mind remains clear till death (CNS)
distended & tender abdomen (GI)
acid burn / eschar is commonly seen as the vomited acid trickles down the
angle of mouth towards the neck & chest
oral cavity: chalky white teeth; swollen, sodden, blackish tongue; swollen
lips (H2SO4)

PM FINDINGS
I)
II)

External:
-corrosion of the part it comes into contact
-clothing: burns, stains
internal: findings restricted to Upper GIT & respiratory tract
-pharynx & oesophagus: inflammatory changes with oedema &
bleeding
-larynx & trachea: corrosion, inflammation, congestion of
respiratory tract is commonest in case of HNO3 poisoning due to
inhalation of acid fumes
-surrounding viscera: sloughing if stomach wall perforated,
perforation : commonest in case of H2SO4 /sulphuric acid

-stomach: soft, boggy black (H2SO4), yellowish (HNO3), brownish


(HCl), which disintegrates on touch
-stomach: swollen, blackish, corroded, desquamated stomach
mucosa (H2SO4)
"contentstarry black or brown" (black: H2SO4, brown: HCl)
CHEMICAL TESTS: For mineral acids & alkalies: only material suitable for chemical
analysis is that found in stomach
i)

H2SO4: BaCL2 barium chloride/Barium nitrate + H2SO4--------BaSO4/barium sulphate(white precipitate); strong acid chars organic
matter
HNO3: HNO3 added by side of a test tube containing strong FeSO4
(ferrous sulphate) & H2SO4(sulphuric acid): a brown ring at the interphase
/ junction of two fluids (FeSO4 & H2SO4)
HCl : AgNO3 (silver nitrate) + HCl-------------AgCl2 (silver chloride: heavy,
curdy, white precipitate of silver chloride)

ii)

iii)

ML Importance:
-

usually accidental : H2SO4 mistaken in place of /for glycerine or castor oil


or liquid paraffin & consumed; accidentally inhalation of vapours in
chemical industries or lab (fuming: HNO3yellow fumes in air, HClfumes
in air; H2SO4: Non-fuming but can one die from inhalation ???)
rarely for committing suicide (HCl, H2SO4, HNO3): can be suicidal
immediate local action
extremely rare in committing homicide : burning acid taste, almost
immediate local action (no lag period), physical changes produced in food
(H2SO4: not used for homicide)
occasionally used as an abortifacient (taken internally or injected into
vagina : H2SO4, HCl)
can result in permanent disfiguration (grievous hurt)-------------------------vitriolage
other injuries may also be present if done out of jealousy, enemity or to
facilitate robbery---vitriolage
criminal disposal of dead body: after killing ---- acids enhance decay of the
dead body(acid bath murder case-John George Haigh killed a lady &
disposed in a steel tank filled with H2SO4)
vitriolage (H2SO4)
xanthoproteic reaction (HNO3)

Physical properties
Features
Synonyms

H2SO4 (sulphuric
acid)
Oil of vitriol

HNO3 (nitric acid)


Spirit of nitre; aqua

HCl (hydrochloric
acid)
Spirit of salts,

Fatal dose
Fatal period
Commercial use
Physical properties

5-10 ml
12-24 hr
In textile, arts &
industries
Non-fuming
Oily/viscid
Charring +ve
Gives heat with
H2O
Burning acid taste
Heavy , colourless

fortis
10-15 ml
24-30 hr
In industries

muriatic acid
15-20 ml
15-24 hr
As cleansing agent

Fumes yellow in air


Not so
Xanthoproteic rxn
+ve
Not so

Fumes in air
Not so
Not so

Choking odour
Heavy, colourless

Not so
Heavy, colourless

Not so