Corrosive Poisons Overview

Corrosive Poisons

• Corrosive poisons cause local tissue damage, with severe oral burns.

• Inorganic acids such as concentrated sulfuric, nitric, and hydrochloric acid are common culprits.

  • A fatal oral dose of these acids is only 4 ml.
  • Poisoning can come from skin contact or inhalation of fumes, or via intentional attack

• Oral exposure causes severe burning pain from the mouth to the stomach.

• Vomiting often contains bloody, acidic pieces of gastric mucosa.

• The colour of vomit can vary -Dark vomit due to acid haemation in sulfuric acid -Black charring in sulfuric acid, and yellow in nitric acid

• The effects also include dehydration and thirst.

• Other symptoms involve oliguria (low urine production) and constipation, shock, weak pulse, hypotension, and evidence of corrosion on lips and mouth.

• Swelling of the glottis (larynx) may cause stridor (wheezing) and cyanosis (bluish discoloration)

• Death can occur in a few hours due to shock and dehydration or after a few days due to perforation and peritonitis.

• If the patient survives, esophageal stricture may occur, causing dysphagia (difficulty swallowing).

Corrosive Acid Inhalation

• Inhalation of acid fumes causes burning pain in the chest, severe coughing, and shortness of breath.
• Swelling of the glottis can also happen resulting in stridor and pulmonary edema – further leading to cyanosis (bluish discoloration of the skin) and death from asphyxia - suffocation
• Bronchopneumonia (lung infection) can also occur

Corrosive Acid Treatment

• Emetics and gastric lavage are often contraindicated due to the possible risk of gastric perforation.
• Diluting the acid by giving water is a recommended action.
• Neutralizing the acid with weak alkalines like magnesium oxide, lime water, or soap solution is also beneficial.
• Milk, egg albumin, olive oil, or butter are alternative options to mitigate the acidic effects, and prevent further damage.

Corrosive Alkalis (Potassium hydroxide and Sodium hydroxide)

• Caustic potash (potassium hydroxide) and sodium hydroxide are used in homes for cleaning purposes and are accidental poison hazards for children.

  • A fatal dose is 3-5 grams of the solid or the corresponding amount of solution.

• Similar to inorganic acids in terms of symptoms, but the mouth mucosa is white.

• Vomis is whitish, slimy (soapy), alkaline, and contains blood.

• The attack period is more delayed than in acid poisoning.

• Stricture of the esophagus is common.

Corrosive Alkalis Treatment

• Treatment involves the same principles as for corrosive acids, avoiding emetics and lavage.
• Neutralizing the alkali with a weak acid, such as lemon or orange juice, dilute vinegar (3-5% acetic acid) in water.
• Further treatment methods include corticosteroids.

Organic Acids (Acetic Acid)

• Glacial acetic acid is highly corrosive.
• Exposure can be via oral ingestion or inhalation of fumes and produces the same picture of acid corrosions accompanied by vinegar-like smell
• The treatment method is the same as that of corrosive acids.

Carbolic Acid (Phenol)

• Phenol is a white crystalline solid, characterized by a strong odor.
• A common form is toilet disinfectant, and other forms like Lysol and Dettol share similar properties.
• Acute exposure causes local tissue necrosis, superficial ulcers, and numbness due to the neurotoxic effect for extended time.
• Sensory nerve endings can be damaged resulting in gangrene, if exposed for long periods
• Systemic absorption from the site of contact can cause central nervous system depression and respiratory distress.
• Fatal dose is 2-4 grams (solid).
• Symptoms include temporary burning pain, colic, vomiting, whitish buccal mucosa, and brownish carbolic eschars (scabs).
• Possible later complications include coma, difficulty breathing, and edema
• Other severe effects include pupils contracted but dilating before death.
• Urine turns green if left in air due to the oxidation of phenol byproducts.

Carbolic Acid Treatment

• Gastric lavage is performed, combined with magnesium sulphate and water given to precipitate the poison.
• To minimize absorption, topical applications should be used, such as 10% ethanol or glycerin as neutralizing agents.
• General supportive care including measures for managing respiratory issues and edema are implemented
• Contaminated skin should be washed with soap and water and then with 10% alcohol

Snake Bites

• There are over 3,000 snake species; only 15% are dangerous.
• Venom is a varied form of saliva secreted through a modified parotid gland.
• Venoms contain enzymes and proteins, causing a variety effects, unlike a single toxin.
• It is produced through a pumping mechanism from an alveolar sac that stores the venom.
• Commonly, venom flows down a tubular fang.
• Though dangerous, it cannot be considered a poison since it isn't inhaled.
• Snake bites are a major hazard for farmers in Africa.
• Some snakes' venomous bites can have benefits for farmers, to combat rodents.
• Antivenoms are produced by injecting horses with venom, monitoring their survival, and collecting their blood for antivenin processing.
• Symptoms include respiratory paralysis, fever, rapid pulse, thirst, dizziness, local tissue damage, blurred vision, nausea, vomiting, diarrhea, coma, and death. (Case Study)

This quiz covers the critical aspects of corrosive poisons, particularly focusing on the dangers of inorganic acids like sulfuric and nitric acid. Understand the symptoms, effects, and potential outcomes of poisoning, including how exposure occurs and the implications for treatment. Test your knowledge about proper protocols for handling these hazardous substances.