Download MBBS Corrossive Poisons 1 Lecture PPT

Corrosive poisoning

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CORROSIVE POISONING

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caustics
Def:
These are the substances ?which fixes, Destroys &
erodes the surface with which, it comes in contact.
Acids are hydrogen containing substances which on

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dissociation in water produce hydronium ions
Action ? with Hb-it forms hematine
-with tissue-it extract water-&
coagulates it
Classification-Acid-organic

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-inorganic
-Alkali
-Others- H2O2,KMnO4, NH4Cl

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CLASSIFICATION
CORROSIVES
ACIDS
ALKALI
INORGANIC

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HYDROXIDE
ORGANIC
SODIUM
AMMONIUM
mineral

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POTASSIUM
HYDROXIDE
CALCIUM
HYDROC
Phosphori

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CARBONAT
SULPHURI
NITRIC
Boric
E

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SODIUM
c
CORBOLIC
OXALIC
C ACID

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ACID
HLORIC
SODIUM
HYPOCHLO
ACID

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acid
ACID
ACID
acid
RIDE

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CALCIUM

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SULPHURIC ACID;

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OIL OF VITRIOL, H2SO4, Olium
It has tendency to carbonize the body tissue
Features-heavy, -colourless, -odourless, nonfuming-liquid
USES: Indistrial chemical, Batteries, Drain Cleaner
Fatal dose - 20 -30cc

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Fatal period- 18-24hr

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SIGNS & SYMPTOMS
-corrosion
-burning pain-epigastrium-mouth to stomach
-dysphagia/dysphonea/dyspnea

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-spreading epigastric pain to throat and
abdomen
-eruct, nausea, vomiting-brown blood
-strongly acid
-charred wal of stomach

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-Intense thirst
-tongue-swol en-black(mouse like)
-teeth-chalky white
-perforation-chemical peritonitis

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After recovery ? scar

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- esophageal stricture
- pyloric stenosis
COD- shock (area col apse)
- spasm/Oedema glottis
- stomach/intestinal perforation

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- toxemia
Delayed death ?pneumonia
-secondary infection
-renal failure
-starvation

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Diagnosis: Litmus Paper-Blue ? Pink
On Stains: Sod Carbonate drops : Effervascence

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Treatment
1) G.L. & Emetics are Contraindicated.

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2) Acid Dilution and neutralized by
-1/4 ltr water/milk/milk of magnesia/lime
water
-Aluminum Hydroxide gel
c/i-alkaline carbonate, sod bi carbonate

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3)demulcent-olive oil/egg white
-milk, melted butter
-mineral oil, starch water
4) prednisolone-60 mg/day-prevents esophageal
stricture shock

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5) Bismuth sub carbonate-2 gm
6) Correct circulatory shock
7) Tracheotomy ?edema glottis
8)Nil oral y-i.v. fluid
-nutrient g/v

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-fluid/soft food
-regular diet
9) Skin burns - wash with water/NaHCO3/apply
paste MgO/ NaHCO3
10)Eye burns - wash with water/NaHCO3

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External-lips/chin/angle-dribbling
-spurting
-teeth- chalky white
-voice- hoarse/husky
-eyes- sunken and dilated

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Clothes- shows stains
- perforations
After recovery ? scar formation

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Postmortem Examination
-External

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?corrosion-skin-chin, angle ,hands
-mucous membrane- lip, mouth, throat
-necrotic area-grayish white
-brown/black & lathery
-clothing ? burns & stains

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Internal:-
upper GIT-swol en/inflamed/intestinal hemorrhages
stomach -soft boggy/black-wet blotting ppr
-mucosal ridge-damaged
-perforation-chemical peritonitis

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-corrosion of organs
kidney-failure

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Test-a. strong acid chars-organic material
b. Ba nitrate/chloride soln.- white ppt.
Of (BaSO4)

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Circumstances-vitriolage
-suicidal-common
-accidental-glycerine
mistaken with -castor oil
-inhalation in factory

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-abortificient

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VITRIOLAGE
Throwing of acid on on the face/body of a
person in order to disfigure /blind him/kill.
Motive : Revange/ Jealousy

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Origin : Glasgow in 1820
Commonly Sulphuric so name derieved/ others
Considered to be grievous Hurt

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NITRIC ACID
It is a Clear, colourless, Fuming, Heavy Fluid
having(peculiar)Choking odour

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Conc. Acid + organic matter-picric acid(yellow
discolouration) -xenthoproteic reaction
SIGNS/SYMPTOMS:
-same as above
-but more eructation & distention

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-& yellow discolouration
Fatal dose :-20-30 ml
Fatal period :-24-30 hr

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-same but yellow patches.
-may be brown/black due to hematin
-perforation less common

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-same as above
Tests-a. solution+FeSO4+H2SO4-brown ring.
b. solution + Ca--pungent+ dark,
brown
heavy

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fumes
Circumstances-accident/suicide

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It is less corrosive in action.
It is a natural constituent of Stomach

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It is a Pungent, colourless, fuming liquid.
-mucus mm is first grey/grayish-white-then
brown/brown-black due to acid haematin
formation
FUMES ?intense irritation throat/lung with

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cough, dyspnoea/suffocation, cyanosis
-coryza/conjunctivitis/corneal ulcer/tooth
loosening
-pharyngitis/bronchitis/gum inflammation

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FATAL DOSE -30-40ml

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FATAL PERIOD -24-30HRS
TREATMENT : SAME
POSTMORTEM EXAMINATION
-same except corrosion less severe
-acute inflammation & edema of respiratory

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passage & lung tissue
TEST-with AgNO3 ? heavy curdy white ppt of
AgCL2 is formed

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c a r b o l i c a c i d

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COLOURLESS, PRISMATIC NIDDLES
HAPED CRYSTAL
BURNING SWEETISH TASTE
IT TURNS PINK WHEN EXPOSED TO
AIR

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PHENOLIC/CARBOLIC SMELL
SLIGHTLY SOLUBLE IN WATER BUT HIGHLY
SOLUBLE IN ALCOHOL, ETHER, BENZENE,
GLYCERINE

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USED AS:

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ANTISEPTIC,DISINFECTANT
DETTOL: CHLORINATED PHENOL WITH TERPINOL
LYSOL : 50% CRESOL IN SAPONIFIED VEGITABLE OIL
PHENYL(HOUSEHOLD):5% PHENOL IN WATER
PRESERVATIVE

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PHARMACEUTICAL
MEDICAL USES-FACIAL PEEL
NEURULYSIS FOR FACIAL SPASTICITY
ABSORPTION:
Through GIT,RESPI,RECTUM,VAGINA,WOUND,SKIN

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Very mild corrosive but act as systemic toxicity
EXCRETION: as hydroquinon & pyrocatacol
FATAL DOSE : 10-30 GM
FATAL PERIOD : 3-4 Hr

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CARBOLISM
Acute poisoning
LOCAL:
SKIN: Burning & Numbness
o White opaque eschar-later brown stain then falls

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o Precipitate protein
GIT: burning pain from mouth to stomach-then
tingling & anaesthesia
o Painfull & difficult deglution & speech
o Corroded Lip,Mouth,Tongue-later white &

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hardened
o Nausea & Vometing
RESPIRATORY: Pulmonary & Laryngeal Oedema
o Bronchitis & Bronchopneumonia

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SYSTEMIC:

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CNS DEPRESANT- Respi Centre Depression
o Headache ,Giddiness, Unconsciousness, coma
o Hypothermia
o Pupil constricted
o Startorious Breathing

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o Pulse: rapid, thready, feble, irregular
o Convulsion, lock jaw,
o Face : cold sweat, cyanosed
URINE: (CARBOLUREA):
o Scanty urine with albumin & Hemoglobin

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o Colourless/Green urine--air--Dark Green/Black

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Treatment:
1. Stomach wash with luke warm water &
animal charcoal/
2. 30 gm of MgSO4 left in stomach

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3. Demulcent-
4. N.S. 7gm soda-bicarb-IV
5. Hemodialysis
6. Methylene blue
7. Skin cleaned with soap & water

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OXALIC ACID
colorless , odorless, prismatic crystal with sour &
slightly bitter taste
USES:

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1. Bleaching & cleaning Agent
2. Ink Removar/ Rust Removar
3. Metal Polishing
4. Industry: Ceramic, Leather, Metallurgic, Paper,
Pharmacutical, Rubber Industry

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q FATAL DOSE: 15-30 gms
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LARGE DOSES: causes shock and then rapid death
q FATAL PERIOD: 1-2 Hrs

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MOA:

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q LOCAL: Corrosive on skin & mucus mm
q SYSTEMIC:
q
HYPOCALCEMIA: Combine with serum calcium to form
Ca Oxalate Crystals ( insoluble) get deposited in the

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liver, kidney, heart, lung, blood & is excreted in urine.
(OXALURIA) ; leading to RENAL DAMAGE
DELAYED: Renal Damage (Uremia): Tubular
Necrosis-uremia-shock-DEATH (1-2 wks)

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CLINICAL FEATURES

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LOCAL:
q CORROSION: whitish/yellowish ? skin/ mucus
membrane later turns blackish due
to acid hematin formation
qScalded mucosa

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q SYSTEMIC:
qVomiting (coffee coloured) & diarrhoea
qTetany:
qTonic muscle spasm, cramping
qAccoucher's Hand : due to carpopedal spasm

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qTrousaeau's sign : spasm due to pressure on vessels
qChovstic's sign :spasm of facial muscle following a tap
on facial nerve area

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qDIAGNOSIS:
qoxalate crystals in urine ?

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Prism/needle/tent/envelop shaped
qSerum Calcium/Oxalate level estimation
qTREATMENT
qStomach wash with Lime water/Ca
Gluconate/Lactate Soln

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qCa Gluconate I.V.--10 ml of 10% soln/wall
scrapings.
qDemulcent
qHemo-Dialysis /Exchange Transfusion for renal
failure

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qWash affected skin/eye with copious water
qSupportive Tt

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AUTOPSY FEATURES
EXTERNAL:
Skin:Brown Eschar

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Mucosa: Whitish mucosa
qScalded mucosa :of Stomach & GIT
qBrown/black colour due to acid hematin
qCrystals of Ca Oxalates on mucosa seen on m/e
qINTERNAL: Congested Organs-Brain, Liver, Kidney.

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qKIDNEY: Cloudy swelling, Necrotic & Hyaline
Changes
qMLI: Accidental for epsom salt (cathartics)

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ALKALI

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Mostly as white powder/colorless soln
Ammonia gas is colorless, with pungent & choking
odour
qUSES:
qAmmonia gas: smelling gas

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qAmmo Hydroxide: paint remover
qSod Hydroxide : Drain cleaner (caustic soda)
q Pot Hydroxide : Drain cleaner (caustic potash)
qSod carbonate : Household cleaning (washing soda)
detergent

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qPot carbonate : Household cleaning
qSod Hypochloride : Household bleach

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qFATAL DOSE: 10-15 gms
q15-20 ml for ammonia
qMOA:

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q Produce Liquifactive necrosisextensive penetrating
damage due to soponification of fat & solublisation of protein
q Ulcer production : persists for several weeks
q Skin : greyish, soapy ,necrotic area, with charring
q Eye : Involvement.

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q Oesophagus is more severely af ected than stomach (contrast
to acid poisoning)
q Ammonia Ingestion : also respiratory symptom

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CLINICAL FEATURES:
vCorrosion of GIT with grayish pseudo-membrane

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vEsophagus severely affecteddysphagia ,
vomiting, drooling, hematemasis
vAbdominal pain, Diarrhoea, tenesmus
vGrayish, soapy, necrotic areas without charring
vEye involvement

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vIn Ammonia, respiratory involvement is also seen

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TREATMENT
Respi Distress: Tracheostomy, endotracheal tube
Diluents: milk/water for adults 1-2 glasses
Neutralization with acid is contraindicated

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c/i? emisis/gastric lavage/catharsis/activated
charcoal
Withhold all oral feed
Assess fluid & electrolyte balance
Eye injury: wash with copous water/saline

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AUTOPSY FEATURES
? Characterstic odour.
? Brown/greyish stain on skin.
? Inflammatory oedema with corrosion & sliminess of
tissue of oesophagus & stomach.

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? Respiratory tract inflammation & Pulmonary
oedema. (Spe : Ammonia )

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FORENSIC IMPORTANCE :
Accidental Poisoning : mistaking as water, bear ,
lemonade.

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Industrial ACCIDENTS :
Suicidal : Occasional
Homicidal : Rare
Robbery : Ammonia used.

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