ORGANIC ACIDS

They differ from inorganic acids in 2 major

forms
• Weaker Local action
• Better systemic Absorption
OXALIC ACID (Acid of Sugar)
Physical Properties
• White, odourless , prismatic crystals with a sour to
bitter taste which resembles Magnesium sulphate

Uses :
1. Bleaching and cleaning agent
2. Ink remover
3. Rust remover
4. Metal Polishing
• Fatal Dose : 15 to 30 gms
• Fatal Period : 1 to 2hrs

Mode Of Action :
• Corrosive Action
• Systemic Absorption Leads to Hypocalcemia and
deposition of crystals in the major organs,
especially the kidneys where it causes tubular
necrosis and uraemia.
Clinical Features
1.Local : Whitish discoloration of skin and mucosa.
Characteristic ‘Scalded’ appearance
2. Burning, Sour, bitter taste in the mouth upto the
stomach
3. Throat Constriction
4. Ocular exposure causes immediate intense pain,
chemical conjunctivitis and corneal abrasions.
• Systemic :
• Vomiting
• Diarrhea
• Hypocalcemia (tetany)
• Pupils are dilated
• Oxaluria

Diagnosis : 1. Urinary oxalate crystals demonstration

under microscope – envelope shaped crystals
2.Estimation of serum oxalate & calcium levels.
 Treatment
1.Treatment involving demulcents (milk, ice cream,
water)
2.Stomach Wash with calcium gluconate
3.Administer Calcium Gluconate IV
4.Haemodialysis or
5.Exchange Transfusion in cases of renal failure.
6.Affected skin or eye must be washed thoroughly
with water.
7. Ocular exposure requires irrigation with water.
 Post Mortem Changes
• Scalded mucosa of Gastro-intestinal tract.
• Examination of cut sections slides of kidney,
stomach, heart and lungs under polarising
Microscope will show crystals of calcium oxalate.

Medico Legal Importance

1.Accidental consumption mainly
2.Occasional Suicidal or Homicidal cases.
3.Malpractices : due to its ink removing property
thieves use it for forgery purpose
 CARBOLIC ACID
• Commonly known as ‘Phenol’

Physical Appearance :
• Pure phenol has a colourless, short, prismatic
needle shaped crystalline form
• Commercial phenol is brownish Liquid
• Household ‘phenyl’ contains 5 % phenol
 Introduced By Joseph Lister who used it as an
antiseptic

Uses :
1.Disinfectant
2.Antiseptic
3.Preservative
 Other Members of Phenol Group
• Cresol
• Creosote
• Resorcinol
• Lysol
• Dettol
• Thymol
Fatal Dose : 10 to 30 gms (crystalline form)
• 25 to 50 ml of household phenyle can cause death

• Toxicokinetics : Rapidly absorbed from GI tract

Lungs, and skin.

Mode of Action : Mild Local effects but profound

systemic effects such as CNS symptoms such as
Depression, Metabolic Acidosis and Renal Damage
 Acute Poisoning
Clinical Features
1. Local
• Skin or Mucosal contact results in mild corrosion
with hardening and whitish discoloration.
• Burning pain , numbness and anaesthesia.

2. Systemic
• GIT – Burning Pain , Vomiting
• CNS – Vertigo , convulsions , coma. Pupils
constricted
• RS – Dyspnoea progressing to respiratory failure
• Blood – Haemolysis , Methemoglobinaemia
• Metabolic – Hypothermia
• Renal – Carboluria & Acute Renal Failure

Chronic Poisoning : Very rare Now a days

• Clinical Features Include Ochrnosis ie deep blue
discoloration of connective tissues.
• Vertigo , anorexia , weight loss.

Diagnosis :
• Typical Smell of Phenol from the vicintiy of the
patient
Ochronosis Externa
• Urine Collected and exposed to air will turn Green .
• Ferric Chloride Test : 10 ml urine + 1 ml of ferric
chloride 10% ------ purple colour which persists
even on heating

Treatment :
• General Supportive Measures
• Decontaminate Skin by washing thoroughly
• Stomach wash with Sodium or magnesium sulphate
as they reduce the bioavailability better than any
other substance.
• If above agents not available , then use act.Charcoal
 Post Mortem Appearance
• Typical Odour of Phenol from the dead body
• White corroded areas around mouth
• Gastric Mucosa is swollen, leathery to touch and
greyish white
• Urine removed and exposed to air turns green

MLI
• Most of the times it is accidental, occupational
exposure
• Formerly Suicidal
 Salicylic Acid Poisoning
Other term commonly used is ASPIRIN poisoning
(acetyl Salicylic acid)
• This occurs as white, odourless, crystalline powder
having acidic taste.
• The acetyl salicylic acid is very extensively used as
an analgesic, and is a component of various
medicines used in the management of fever,
skeletal pain, control of inflammation, arthritis,
etc.
 Fatal Dose
• Fatal Dose : 5-10 gm of aspirin is the minimum fatal
dose . Death may occur due to hypersensitivity
reaction, even with one tablet. ( Idiosyncrasy )
• Reye’s Syndrome : In Some Viral Fevers such as
chicken pox and similar ones, use of aspirin in
treating the fever may result in Fatal syndrome
which includes Complete CNS failure and Death.
• Hence Paracetamol is widely used for treating
Fevers
 Clinical features
• Headache, dizziness, thirst, epigastric distress,
• nausea and vomiting are common features.
• Hematemesis may also occur.
• Swollen face, weak and rapid pulse, hyperpnoea,
• Profuse perspiration and dehydration may be seen.
• Mental changes commonly known as salicylate
gags may be there followed by drowsiness and
coma.
• Hypersensitivity to salicylates has been also
reported. There may be anaphylactic reaction,
• urticaria and angio-neurotic oedema
• Later, metabolic acidosis supervenes due to
increased excretion of bicarbonate,
potassium and sodium.
• Renal function may be disturbed. Toxic
encephalopathy may occur.
• Death may occur due to cardiac or
respiratory failure
 Treatment
• Gastric lavage should immediately be done with
normal water, and activated charcoal should be
given.
• Kidney function may be taken care of by giving a
lot of fluid either by oral, or intravenous route.
• Metabolic acidosis should be corrected by giving
sodium bicarbonate.
• Hemodialysis or peritoneal dialysis should be done
at the earliest.
• Vital functions should be maintained by
giving oxygen and intravenous solutions.
• Vitamin K should be administered if clotting
time is prolonged.
• Forced alkaline diuresis is the key treatment
to achieve a urinary pH of more than 7.
 Post Mortem Changes
• The gastric mucosa may show haemorrhages
and ulcerative lesions.

• In brain haemorrhage may be seen.

• Rest of the findings are non-specific.

 Medico Legal Importance
• Accidental poisoning is common

• Suicidal poisoning is very less but reported.

• Homicidal poisoning is very rare as very large

doses are required to kill a person.
 ALKALIS

Mechanism Of Action
The action of alkalies is like that of acids.
They produce corrosions when administered in
concentrated form. They act as irritants when
administered in diluted form.
Strong alkalies can produce burns in oesophagus
and may cause oesophageal stricture.
• The common alkalies are as follows:
• 1. Ammonia: The chemical formula is NH3.
The gas of ammonia when dissolved in water
forms a strong ammonia solution commonly
also called ‘spirits of Hartshorn’.
• It is a very strong alkali with a pungent odour.
It is commonly used in refrigeration and
fertiliser industry.
2.Potassium Hydroxide: The chemical formula
is KOH. It is hard, deliquescent and is
available as pencils or cakes.
It is soapy to touch, acrid in taste and is very
soluble in water.
It is a highly strong alkali.
• Sodium Hydroxide: The chemical formula is
NaOH.
• It is a white, solid mass and resembles
potassium hydroxide.
• Highly soluble in water and is a very strong
alkali.
• Mixture of sodium and potassium hydroxides
is commonly referred to as ‘lye’. It is used for
drain or oven cleaner.
• Ammonium Carbonate: The chemical formula
is (NH4)2 CO3.
• It occurs as translucent, hard and crystalline
mass.
• It is quite soluble in water and emits smell of
ammonia. It is a very strong alkali
• Potassium Carbonate: It is also known as
‘pearl ash’, ‘salt of Tartar’ or ‘Javakhar’.
• It is a white, crystalline powder.
• It is a very strong alkali, used mainly for
cleaning purpose.
• Sodium Carbonate: It is also known as
‘washing soda’, ‘Sajjikhara’, or simply as soda.
• The chemical formula is Na2CO3.
• It is transparent, monosymmetric crystal and
becomes white when exposed to air.
• It is quite soluble in water.
• It is a strong alkali, commonly used for
washing and cleaning purposes.
 Clinical Features
1. The taste of alkalies is acrid and soapy.
2. The vomited matter is very alkaline and does not
effervesce as in acids when comes in contact with
earth.
3. Purging is quite common in alkalies while it is rare
in acids.
4.Severe pain with bloody diarrhea may be seen.
5. The ammoniacal vapours are very irritating to
respiratory systems. They produce congestion and
watering of eyes too.
• The ammoniacal vapours are very irritating to
respiratory systems. They produce congestion
and watering of eyes too.
• Pulmonary oedema may be seen.

• Fatal Dose : 30 ml of ammonia is fatal. 5 gm of

caustic soda is fatal.

• Fatal Period : Within 24 hours, death can occur.

 Treatment
• Gastric lavage is contraindicated in strong alkalies.
• Alkalies may be neutralised by vegetable acids like
vinegar, lemon or orange juice.
• It should be followed by olive oil or white of egg,
milk, etc.
• Rest of treatment on conservative lines, is same as
that of acids.
• The oesophageal stricture should be handled
surgically
 Post Mortem Appearance
• Characteristic Odour (in Ammonia)
• Brownish or greyish staining
• Corrosions are seen in alimentary canal but
not as extensive as seen with mineral acids.
• Perforation is rare but may be seen in
ammonia poisoning
 Medico Legal Importance
• Most of the poisoning is accidental or
suicidal.
• Homicidal poisoning is very rare.
• Caustic soda may be locally applied to neck
of ox or buffalo to make it unfit for
agricultural purpose, so that it would not be
able to bear yoke of a plough due to the local
corrosive effect of caustic soda