170 Toxicology

---Active space ----- CORROSIVEPOISONS

AKA caustics.

Corrosives 00:00:18

TYPES
Acid Alkali

Necrosis acic) Liquefactive

Coagulative (Except hydroAluoric
Eschar Formed Absent

Lateral spread Restricted Unrestricted (Faster)

Injury Super tcial, less severe Deeper, more severe

mucosol
Gastric > esophageal Oesophageal > Gastric
involvement

Inorganic organic
Clinical LOcal +
features LOcal efects only Sustemic effects
o/t absorption)
Sulphuric acid. • Carbolic acid • Sodium carbonate.
• Nitric acid. (Pheno). Potassium carbonate.

Examples Hydrochloric acid. • Oxalic acid Ammonia.

Hydrolouric acid Formic acid. Potassium hydroxide.
• Acetic acid. Sodium hydroxide.

CLINICAL FEATURES

Pain : a. chemical peritonitis :D/t pertoration.

I.
Odynophagia (m/c). 3. Dyspnoea fstridor :
D/t airway involvement.
Throat. 4. Vicious cycle : Intense thirst
• chest. |Consumption of Muid
• Abdomen.
Severe yonmiting

Regurgitationof broun (elood

stained) acidicvomitus

D Injury
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 Corrosive Poisons 171

Sulphuric Acid & Nitric Acid 00:08:27 ----- Active space

SULPHURIC ACID

AKA Oil of Vitrio/batteryacid.

roperties

Carbonisation (Charring)
Hygroscopy:
Black necrotic Absorption of moisture
SKin

Tongue.
Stomach :wet blotting paper
Chaky (orwhite teeth
consistency (Fragile).

Appearance
Perforation

Chemical peritonitis

Appearance

Sffr Ard

NITRIC ACID

AnA Aqua fortis/spirit of nitrate.

Xarthoproteic reaction :
Skin
Tissues Skin + Nitric acid Yellow
Picric acid Teeth
qmucosa) staining of
mucosa

Note :Stomach mucosa can be dark broun d/t digested blood

Vitriolage 00:12:00
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Intentional throuing of any corrosive substance with the intention to distqure a

person.

Commonly used:
Sulfuricacid.

t6Nitric acid
Juice of Semecarpus anacardium.
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LL

Vitriolage
 172 Toxicology

--1Active space CLINICAL PRESENTATION

•Chemical burns on exposed region (Face,neck.

Corrosionulceration.

No Singeingof hair/No bisters (Except tormic acid).

:
Complication Contractures.
[email protected]

MANAGemeNT
Topical irrigation :water/normal saline.

Topical paste of magnesium oxide(ngo).

meDICOLEGAL IMnPORTANce
•397 BNSS: All doctors should provide compulsory freetreatmentto victims of
Vitriolage and sexual erimes and inform police of the incident.
Violation : Punishable under aoo BNS.

la4

• la4
:
BNS Detnes punishment for acid attack.
a)SNS :Defnes punishment Por attempt of acid attack.
Carbolic Acid (Phenol) 00:16:03

APPLICATIONS

Antiseptic.

• Disinfectant.
On expOSure to air

Phenol crystal Phenol liquid

Phenol derivatives :Cresol, Resorcinol, Lysol, Dettol.

PHENOL POISONING
Absorbed through all routes (ncludingintactSskin).
:
• Acute Carbolism.
• Chronic :Phenolic marasmus.

Clinical presentation of carbolism :

Local efects :

eurning pain ínitialy

sensory nerve endings.

Tingling and numbness - Anaesthesia (bamage

•
D lEmesis : D/t anestheticefect.
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Leathery buff white stomach mucosa/thickening :Gastriclavage done.
 Corrosive Poisons 173

Systemic effects : ----- Active space

into blood
Absorpton

Toxic metabolite :Pyrocatechol, hydroquinone

Blackish staining CNS CVS: Renal:

of tissues : • CNS depression Shockf Carboluria: olive qreen/
Ochronosis Convulsions dark colour on exposure
hypotension
Constricted pupils to air

Proximal tubular necrosis

Oliqur ia, renal failure

Autopsy Andings :
Delayed putrefaction:D/t antiseptic property inhilbit bacteria).

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Oxalic Acid Poisoning 00:23:54

Acid of sugar/salt of sorrel.

used in ink/rustremoving liquid: Signature torgery (Punishableunder 336 BNs).

Source :vegetables, corn, spinach,almonds etc.

CLINICAL PRESENTATION

Local effects : In GIT Pain, vomiting).

Systemic effects: Absorbed in blood

+Caat
Calcium oxalate crystals
Calcium oxalate crystals Hypocalcemia

Oxaluria: Dumbbel/envelopeshaped Features of tetany:

Chvostek sign
monohydrate casts
Trousseau siqn

Xereted in urine Tubular precipttation

at concentration

Proximal tubule damage Renal Pailure

mANAGemENT
Gastric lavage :using calcium lactate solution (withcaution).
O Antidote:V calcium gluconate.

Hemodialysis.
LTreat renal toxicity
 174
Toxicology

-Active 00:29:40
space Hydrofluoric Acid Poisoning

Inorganicacid witth both local and sustemic etfects.

• Absorbed via skin

• Causes liquetactive neerosis.

RISK FACTOR

Occupational exposure :in glass etching.

PATHOGeNESIS

Acid produces H and Fluoride ions.

Fluoride ions Liquefactivenecrosis Faster local spread(Damage skin,

deeper tissues, bones).

CLINICAL PRESENTATION

EXcruciating burning pain disproportionate to amount of exposure.

Forms insoluble salts with calcium and magnesium:
• Hypocalcemia.
Hypomagnesemia.
HYperkalemia.

MANAGemENT
• ICU admission.
Continuous ECG monitoring :watch or anrhytthmias.
• Correctionof electrolyte imbalance.

Boric Acid 00:33:18

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eoied lobster sundrome i

Desquamation

Skin of peripheries Sweling

erythematous

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