Alkalies & inorganic acids corrosives Organic acids corrosives

Clinical picture 1- Ingestion A) Carbolic acid (phenol) B) Oxalic acid

-Pain in pharynx chest or abdomen. • Skin contact: - edema - erythema - necrosis 1- local action: (weak corrosion on the stomach and skin)
-Vomiting -Dysphagia. – Salivation. • Ingestion • Acid sour taste in mouth with burning pain from mouth to stomach.
-Erythema, edema, erosions with patches of necrosed tissue in the 1- Local action (mild corrosive) • White patches on lips.
lips, tongue and mouth cavity. - Transient pain, transient vomiting due to local anesthesia of mucous membrane • Severe vomiting: brown in color with white crystals of the poison.
-Respiratory distress - Fever and shock. and thick gastric wall (coagulation of protein). • Diarrhea & tenesmus if the poison reaches the intestine.
- Diarrhea because phenol is re- excreted in large intestine. • Collapse: weak rapid pulse & hypotension.
2- Inhalation - Greyish or brown patches on mouth (coagulative necrosis). • Skin cracking, slow-healing ulcer.
– Bronchospasm 2- Remote action: Phenol poisoning can be recognized by the characteristic odor
- Rarely non-cardiogenic pulmonary edema.(marked by on the breath
crepitation) 2- Remote action: (fatal hypocalcemia & formation of calcium oxalate
1-C.N.S. Stimulation: Headache, Delirium & Convulsion crystals)
3- Skin contact
- Classical symptom of thermal injury: erythema & full thickness Depression: Stupor & coma chracterised by subnormal
skin loss. No plustring as it’s hydroscopic. temperature, miosis, cyanosis and central respiratory 1- CNS & Weakness, carpopedal spasm, twitches &
4- Eye contact failure. Muscles generalized convulsion. Lastly respiratory muscles
Conjunctival injection & corneal ulcer or burn.
2- Kidney -Urine is dark, and then turns green on exposure to air are affected
because of oxidation of metabolic products of phenol. 2-Kidney Oliguria, hematuria, anuria and renal failure

-Oliguria, hematuria, albuminuria and renal failure.

3- Heart Bradycardia, arrythmia and cardiac arrest
3- Heart Tachycardia, hypotension, arrhythmias and shock

4- Liver Hepatic injury may occur.

5- Blood Methemoglobinemia as it is an oxidizing agent

Investigations 1- Laboratory investigations:

• Electrolyte 《effect in Vomiting 》and renal profile
• Arterial blood gases (ABG)
-Alkaloids: Alkaline ingestion, severe Vomiting.
-Acidosis: Acid ingestion, severe diarrhea, dyspnea, hypoxia.
2- Radiography:
• Chest and abdominal radiographs are used to detect gross signs of
esophageal or gastric perforation.
Signs of perforation that may be seen on plain radiographs include
pneumomediastinum, pneumoperitoneum, and pleural effusion. Free
intraperitoneal air is best seen on an upright chest radiograph.
• A contrast esophagram is useful for defining the extent of esophageal
injury. Late after the ingestion, it can detect stricture formation.
3-Endoscopy: after 12h before 24h
It should not be passed beyond the first circumferential burn,
contraindicated if respiratory distress is present.
3- ECG (serial) will detect early appearance of pericarditis and
mediastinitis
Treatment: 1- Prevent further exposure.
2- Emergency & supportive treatment: • Care for respiration [oxygen & artificial respiration] 1- Emergency & supportive measures:
• Pain killers. (Paracetamol) • Care for myocardial failure • Oxygen inhalation & artificial respiration in case of cyanosis caused
• Stabilization of vital signs of the patient including ABC [digitalis may be needed] by spasm of
 •Care for kidney [haemo or peritoneal dialysis]. respiratory muscles.
•fluid for dehydratio • Correct convulsion (relived by calcium replacement).
3- Decontamination: Decontamination: 2- Decontamination:
• Ingestion: • Gastro-intestinal: • Gastro-intestinal: gastric lavage is done by calcium hydroxide or milk.
- Demulcent therapy: One or two glasses of cold milk or iced powder Gastric lavage is done followed by activated charcoal and cathartic as sorbitol. Milk is oral antidote because it is rich in calcium and demulcent &
are given to the adult within 30 minutes (given in multiple small • Skin & eye: by tap water. buffer.
amounts for fear of inducing vomiting). • Skin & eye: as in general toxicology, ophthalmologist & dermatologist
- No neutralization, no emesis, no gastric lavage, no activated charcoal consultation is advisable.
and no catharsis.
• Inhalation:
- Observe carefully for signs of progressive upper-airway obstruction - 3- Enhancement of elimination: 3- Enhancement of elimination:
Intubate the trachea if necessary. • Hemodialysis in case of impairment of renal function • Wash out calcium oxalate crystals from renal tubules by alkaline
- Use bronchodilators for wheezing intra-venous fluids.
- Treat noncardiogenic pulmonary edema 《peep, corticosteroids, fluid • Hemodialysis in case of impairment of renal function.
according to need》.
• Skin and eyes:
- Remove contaminated clothing and flush exposed skin immediately
4- Physiological antidote:
with copious cold water.
Calcium by every possible route (initial treatment):
- Irrigate exposed eyes with water or saline
• Calcium gluconate: 10 ml slowly I.V. with electrolyte and ECG
monitoring.
• Calcium hydroxide: orally or via gastric tube to precipitate oxalic acid
in stomach as calcium-oxalate.

4- Symptomatic treatment: 4- Symptomatic treatment:

• Steroids: to prevent fibrosis, in (stridor, bronchospasm or acute • Treatment of methemoglobinemia if present by methylene blue.
pulmonary edema). • Acidosis give Na HCO3.
• Antibiotics to guard against infection. • Intra-venous fluids for dehydration.
• Panthenol gel for affected skin.
• H2 blockers (ranitidine) to minimize HCL secretion.
• Total parenteral nutrition (TPN) for at least 3 weeks.
• Surgical interference according to the severity of the case.
• Ophthalmic consultation is indicated.

Complications of corrosive exposure: A) Carbolic acid (phenol) Oxalic acid

1- Upper respiratory tract obstruction and pulmonary edema.
2- Mediastinitis, pericarditis and pleuritis.
3- GIT hemorrhage, perforation and fistula formation.
4- GIT obstruction, stricture and cachexia.
5- Septicemia.
Cheap, available, cause local anesthetic effect the systematic effect.
• Pure form is crystalline, colorless but commercial form is brown
• It has a characteristic odor due to the presence of coal–tar derivatives
as Dettol, Lysol
& cresol.
• It is one of the oldest disinfectants.
• Colorless prismatic crystals that may be mistaken with sugar.
• Widely used in leather, dye painting.
• In house-hold cleaning of copper, other metals and for
removing stains.