University of Gondar

College of Medicine and Health Sciences

School of Pharmacy
Department of Pharmacology
Course: Advanced Toxicology
Assignment on caustic and corrosive agents
(acids&bases)
To: Mr. Assefa Belay (Assistant prof’’ of pharmacology )

By: Nardos Lema

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 1

Objective

Understand about corrosive agents

Potential usage and their toxicity

What causes toxicity

The mechanism for toxicity

How to prevent and reverse toxicity

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 2

 Out lines

Introduction

Sources of exposure for toxicity

Toxicokinetics

Toxicodynamics

Diagnosis &CP

Management

Prevention

conclusion
03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 3
Introduction
Corrosives are substances that have corroding and
destructive effect on the human body.

The term "caustic" mainly referred to strong bases.

They are almost exclusively locally acting and have very

few systemic effects.

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 4

 Introduction…..cont.

Caustic corrosion can also happen in metal equipment

(e.g., boilers) by resulting in an operating medium that is
highly alkalized

Leading to stress, cracking, dissolving the material and

finally brought equipment failure

They cause tissue injury by a chemical reaction and can be

classified as follows;

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 5

Introduction…..cont.

Strong acids

Mineral/inorganic acids: sulphuric, nitric, hydrochloric

acid

Organic acids: carbolic acid, oxalic acid, acetic acid and

salicylic acid.

 Strong alkalies

hydrates and carbonates of sodium, potassium and

ammonia.
03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 6
Introduction…..cont.
Other agents

oxidizing agents, denaturants, some hydrocarbons,

and agents that cause exothermic reactions.

Button batteries

small, disk-shaped batteries used in watches, calculators, and

cameras. They contain caustic metal salts that may cause corrosive
injury.

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 7

Sources and route of exposure
Accidental ingestion usually or rarely suicidal gesture,
inhalation, eye or skin contact of various household products
such as detergents and drain openers which contain alkaline
corrosives.

Acute and prolonged exposure through inhalation to the

vapours of these agents in the industries.

 These agents and their salts are constituents of food and

medicine.
03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 8
Sources and route of exposure…..cont.
For instance;

 we eat fruits containing organic acids

The curd of the milk contains lactic acid

 Acetic acid is used directly to enhance the flavour of food

 Sulphuric acid is used in the manufacturing of drugs

 antacids, which usually contains baking soda or magnesium

hydroxide

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 9

Sources and route of exposure…..cont.
→ So to much taking of this agents might cause GI fluid
abnormality, devastation and potential to cause systemic
complication.

Since exposure to ingestion of these agents is high.

→ It is Important to ascertain their state of

condition, level of amount… etc.

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 10

Toxicodynamics
The severity of chemical injury depends upon the corrosive
nature , the quantity, concentration and duration of contact.

Mechanism of toxicity

Acids

cause an immediate coagulation-type necrosis that creates

an eschar,which tends from self-limit to further damage.

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 11

Toxicodynamics…..cont.

Alkalis

cause a liquefactive necrosis with saponification so that

penetrating into deeper tissues and result an extensive
damage.

Other agents

may act by alkylating, oxidizing, reducing, or denaturing

cellular proteins or by defatting surface tissues.
TOXICOLOGY OF COROSSIVE AGENTS 03/05/2025 12
Toxicodynamics…..cont.
Button batteries

the leakage of the corrosive metal salts cause direct

impaction of the body and local discharge of electric current
at the site of impaction → corrosive injury

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 13

Diagnosis and clinical presentation
 Diagnosis

based on a history of exposure, findings of skin, eye, or

mucosal irritation or redness and the presence of injury to
the GI tract.

Endoscopy

May prevail GI injury in asymptomatic patients.

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 14

Diagnosis and clinical presentation…..cont.

Radiographs

Air in the gastric wall is an ominous sign of an impending

perforation.

Routine lab tests: CBC,Electrlyte,ABG,urine level of agent

To evaluate for organ dysfunction, aspiration

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 15

Diagnosis and clinical presentation…..cont.

Clinical presentation

Inhalation of corrosive gases (e.g., chlorine and ammonia)

Pulmonary symptoms: stridor, hoarseness, wheezing

Eye or skin

Immediate pain, redness, blistering, Conjunctivitis and

lacrimation till blindness can occur.

Ingestion →dysphagia, severe oral chest or abdominal pain

Systemic toxicity→ acidosis, electrolyte disturbance,arrythmia

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 16

 Table 1: corrosive agents with systemic effects (adapted from poisoning and drug overdose
6th edn p 168.
TOXICOLOGY OF COROSSIVE AGENTS

03/05/2025 17
Management
Non pharmacological

Decontamination

Remove from exposure & give supplemental O 2

wash skin and irrigate eyes with copious water or saline.

Not induce emesis

Give water or milk to drink.

Gastric lavage→ probably beneficial in acute liquid corrosive

ingestion
03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 18
 Management….cont.
Pharmacological

For most agents, there is no specific antidote

Steroids may mask early signs of inflammation and inhibit

resistance to infection in patients with perforation.

Antiemetic (e.g., ondansetron, 8 mg IV in adults or 0.15 mg/kg

in children to prevent additional esophageal injury from emesis.

PH-neutralizing solutions (e.g., dilute vinegar or bicarbonate)

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 19

Management….cont.

Activated charcoal may be appropriate if systemic toxicity

happens otherwise it may interfere with visibility at
endoscopy.

Broad-spectrum antibiotics and aggressive management of

hemorrhage and septic shock in patients with mediastinitis or
peritonitis.

Some specific types of corrosions are illustrated below

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 20

Organic Acids
They are weaker in action and are usually absorbed into
circulation and so have both local and remote action.

Carbolic acid (Phenol/Phenic Acid)

Since used as antiseptic,disinfectant,preservative and germicide,

acute intoxication can be resulted from cutaneous exposure,
ingestion and chronic intoxication from inhalation of vapours from
industries.

10–15 gm. is the usual range of the fatal dose.

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 21
Carbolic acid…….Cont.
Has rapid absorption, distribution and excretion as free
form or conjugate mainly in urine and trace amount via
faces

Follows saturation metabolism → at high dose

saturation of conjugation leads to increases in CYP2E1
oxidative metabolism primarily to hydroquinone and
catechols →radioactive spp→methemoglobinemia

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 22

Carbolic acid…….Cont.
presented with respiratory distress, strong carbolic acid odour
in the mouth with hardening and whitening of the mucous
membrane of lips & mouth, a deep white patch followed by
brown stains in the skin.

urine phenol levels > 20 mg/L.

cardiac arrhythmias and CNS stimulation,

Acute renal failure due to direct toxicity or chronic due to

hemolysis and hypotension.
03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 23
Carbolic acid…….Cont.
 can be managed as; If cutaneous exposure, thoroughly washed
with soap solution or 25% alcoholic solution & some vegetable oil.

If ingested→ gastric lavage since unlike other corrosives it

hardens the gastric wall so lavage with sodium or magnesium
sulfate solution to reacts with phenol and form harmless salt

No specific antidote is available. If methemoglobinemia occurs,

administer methylene blue.

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 24

Oxalic acid (Acid of sugar)

Cutaneous exposure is common since used as a bleaching agent in

industries,laudary powder. Can also be ingested from food &drugs of
vegetable origin (spinach,cabagge,onion,lichens)

15–20 gm. ingestion usually causes fulminating poisoning and death.

Oxalic acid is poorly absorbed, rapidly cleared from the plasma pool
and excreted unchanged in the urine as the parent compound or as
calcium oxalate or degrade by intestinal bacteria to CO2.

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 25

Oxalic acid……Cont.
Plus to its corrosive action on the mucous membrane, after
reach to the system it combines with serum calcium to form
insoluble calcium oxalate thereby resulting → renal tubular
necrosis
→ hypocalcaemia
→muscular collapse

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 26

Oxalic acid……Cont.
Can cause acute renal failure,convulsion,cardiacarrest,and can develop
urolithiasis and slow healic ulcer chronically.

Diagnosed by presentation of bleached or brownish streaks on the

mucous membrane of skin,stomach,QT prolongation on ECG.

Can be managed by → caring insertion of soft stomach tube to lavage

by calcium lactate.

→ giving 10 ml of 10% calcium gluconate PO or slow

IV infusion to save the serum calcium.

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 27
Mineral Inorganic acid
Sulfuric acid

Since it widely used in the manufacturing industries

exposure to toxicity can occur through skin, eye contact,
ingestion, and inhaling the contaminated air.

Oral exposure to sulfuric acid can cause severe gastric

perforation

Little absorption from the mucous membrane of skin

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 28

Sulfuric acid……Cont.

Following inhalation exposure readily absorbed from the upper

respiratory tract and H2SO4 is highly soluble in water

In contact with water dissociate into hydrogen ions and

hydrated sulfate ions and excess sulfate is excreted in the urine.
 Sulfate is a metabolite of sulfur amino acids,

 Mechanisms of toxicity

result of pH change rather than a result of sulfate

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 29

 Sulfuric acid……Cont.

Changing extracellular and intracellular pH

Since pH plays a critical role in control of cell growth and differentiation, the
change of PH causes cellular changes if hydrogen ions reached to susceptible
targets. Adding to this sufficiently low pH is genotoxic to some cell systems

Lowering the PH of the mucous→↑viscosity ↓mucociliary clearance.

Induce chronic tissue inflammation→release of free radicals -genitotoxic

- ↑ susceptibility to infection

- contribute to carcinogenesis

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 30

Sulfuric acid……Cont.

The main acute toxic effect are corrosion on the contact surfaces and
repeated exposure can cause nasal bleeding,cough,dental erosion, risk of
laryngeal cancer.

A decrease in saliva PH,pulmonary resistance, presence of pharyngeal

pain, vomiting of dark brown or black matter, intense of
thrisit,dysponea,dysphagia aids for diagnosis.

Managed by Preventing the change of PH in tissue by cautious dilution

or neutralization by milk, milk of magnesia, limewater and if skin and
eye burns present irrigate by large amount of water or NaHCO3 solution.
03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 31
Nitric acid (HNO3)

exposure is most likely via inhalation in occupational setting.

Not absorbed after oral administration instead cause severe GI

distress.

Following an acute exposure via inhalation it reacts immediately

with respiratory mucous membranes → Respiratory distress.

Or some may decompose to other nitrogen oxides, which might be

absorbed by the bloodstream →to cause delayed toxicity by
producing methemoglobinemia.
03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 32
Nitric acid…..Cont.
Repeated or long term exposure→
Via inhalation→chronic bronchitis,AHA,enamel erosion,

via ingestion→Yellowing to teeth may occur

Via dermal/occular→erythema, dry scaly appearance.

 Extensive yellow colouring of the affected skin and mucosa

(xanthoprotein reaction) is a characteristic feature of this acid.

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 33

Hydrochloric acid (HCl)

Exposure is most likely via inhalation of hydrogen chloride

vapor or aerosols of hydrochloric acid at occupational setting.

Upon contact with water hydrogen chloride forms hydrochloric

acid for which skin or eye exposure or ingestion is most common.

Because of high reactivity of HCl with the upper respiratory

tract, plus partially neutralization by naturally occurring ammonia
gas in the respiratory system,→→significant systemic exposure
to HCl is unlikely
03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 34
Hydrochloric acid…..Cont.

HCl dissociates in water to form hydronium ions (H30+) that

can interact with tissue elements, resulting in cell injury or
death.

A rare and unusual complication of ingestion of high levels

of hydrogen chloride is an increase in the concentration of
chloride ions in the blood, causing an acid-base imbalance.

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 35

Alkalis

Sodium Hydroxide(NaOH)

exposure can happen via inhalational of sodium hydroxide

dust, mist, or aerosol or via direct dermal/eye contact with the
solid or the concentrated solutions.

Since alkalis cause liquefactive necrosis, NaOH cause

breakage of disulfide bridges bonds in proteins.
 solubilisation of proteins plus
 saponification of cell membrane lipids cellular.
 disruption of the protective permeability barriers death

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 36

Sodium Hydroxide….Cont.

Acute and chronic toxic effect

→via inhalation causes fluid accumulation in the lung

&larynx.

→via skin cause burns to dermatitis.

→via eye cause corneal ulceration to blindness

→via ingestion cause GIperforation,shock,gastritis.

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 37

Prevention
 Labeling the containers to prevent accidental ingestion

Wearing Personal protective equipment's at occupational

settings (respirator, clothing, apron, face shield,gloves,
boots).

Limit unrestricted access to these agents.

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 38

Conclusion
 The local corrosive nature of the mineral caustic agent is
more responsible for their toxicity.

Many of the agents have not specific antidote so

management of toxicity is via decontamination,
supplemental oxygen,stabilishing Iv line for circulatory
compromise, copious irrigation with fluid and neutralization.

03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 39

 References
Poisoning & Drug Overdose, 6e

Vij K. Textbook of forensic medicine and toxicology: principles and practice, 5/e.
Elsevier India; 2011.

Hodgkinson A, Zarembski PM. Oxalic acid metabolism in man: a review. Calcified

tissue research. 1968 Dec;2(1):115-32.

Trioxide s. Toxicological profile for sulfur trioxide and sulfuric acid.

Bull S, Chapd HQ. Hydrogen chloride/hydrochloric acid: toxicological overview.

Nitric acid Toxicological Overview December 2017

Occupational exposure to sodium Hydroxide U.S. Department of Health, Education,

and Welfare public health service center for disease control
03/05/2025 TOXICOLOGY OF COROSSIVE AGENTS 40