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    Corrosives/caustics Corrosives/caustics Presentation Transcript

    • CORROSIVES They are substances that destroys the body tissues with which they come into contact . They are: ACIDS ALKALIS OTHERS
    • ACIDS  Inorganic/Mineral acids-sulphuric acid HCl,HNO3  Organic-oxalic acid,acetic acid,formic acid.
    • SULPHURIC ACID SYNONYM:oil of vitriol,oleum PROPERTIES: heavy,colourless,hygroscopic,non- fuming USES:Batteries,industries,drain/toilet bowl cleaners,vitriolage FATAL DOSE: 20-30 ml TOXICOKINETICS: No absorption
    • MECHANISM OF ACTION Acids Release hydronium ions Protoplasmic coagulation Coagulation necrosis
    • SIGNS AND SYMPTOMS  Burning sensation of GIT  Intense thirst,  Tongue-swollen,turns black/brown  Teeth-chalky white  Drooling  vomiting  Dribbling marks on face  Stomach-perforation-peritonitis  Strictures form pyloric obstruction,antral stenosis
    • DIAGNOSIS  Litmus test:blue-pink  Clothing stains+ few drops of sodium bicarbonate,produces effervescence
    • MANAGEMENT  Decontamination of skin  Respiratory distress  Demulcents  Emergency laparotomy  Corticosteroids,antibiotics
    • THE DONT’S  No oral feeds  No emetics or charcoal  No gastic lavage  Neutralisation with alkalis is dangerous
    • HYDROCHLORIC ACID  SYNONYMS:Muriatic acid,Spirit of salts  PROPERTIES:colourless,fuming,turns yellowish with air.  USES:bleaching agent,dyeing industry,metal refinery,preparation of Cl,metal/drain/ceramics cleaner.  MEDICINAL USES:achlorhydria,Hb estimation.
    •  FATAL DOSE:30-40 ml  TOXICOKINETICS:no absorption  DIAGNOSIS: 1.litmus test 2.Stomach contents/vomitus + conc ammonia White fumes of ammonium choride
    • MECHANISM OF ACTION HCl Hydronium ions Protoplasmic coagulation(tissue proteins),forms coagulum. Coagulation necrosis Tisssue damage
    • SIGNS AND SYMPTOMS  Same as sulphuric acid poisoning  It produces pronounced respiratory distress  Greyish discolouration  Less chance of perforation  It produces less severe effects since HCl is naturally present in the body
    • MANAGEMENT  Same as for sulphuric acid poisoning  Severe pain-morphine is given  Eye injury-retraction of eye lids+prolonged irrigation with normal saline or lactated ringers soln,15-30 min  Regular follow-up for strictures/stenosis,if present,dilatation or esophagogastrotomy done.
    • NITRIC ACID  SYNONYM:aqua fortis,red spirit of nitre.  PHYSICAL PROPERTIES:colourless,yellow fuming liquid,choking odour,dissolves all metals except Pt & Sb.  USES:engraving,electroplating,gold smith- aqua regia(HNO3:HCl::3:1),fetilisers  TOXICOKINETICS: absorption is negligible  FATAL DOSE:20-30 ml
    • MECHANISM OF ACTION Reacts with protein & orgaic matter to produce trinitrophenol Liberates nitogen monoxide,xanthoprotein is formed It produces yellow discolouration of skin,coagulation of tissue proteins Produces coagulation necrosis
    • SIGNS AND SYMPTOMS  Teeth-turns yellow  Respiratory tract- coughing,rhinorrhea,dyspnoea  Abdomen-distention due to gas formation,less perforation  Oliguria with cast and antibodies
    • DIAGNOSIS  Litmus test  Stomach contents+copper when heated pungent,heavy,dark brown fumes THERAPY Same as for sulphuric acid poisoning The respiratory tract should be more secured.
    • ALKALIES Examples include: Ammonia- Ammonium hydroxide-paint,oil,refrigerant Ammonium bisulphate-fertiliser Sodium hydroxide-drain/oven cleaner Sodium carbonate-household cleaning agent,detergent pot.hydroxide-drain cleaners,hearing aid
    • PROPERTIES: Ammonia:colourless,pungent,choking Alkalis:white powder,colourless solns. FATAL DOSE: Ammonia:15-20 ml,pot.carbonate:15 gm Sod/pot hydroxide:5 gm, sod.carbonate:30 gm TOXICOKINETICS: No absorption
    • Signs and symptoms  Skin- greyish,soapy,necrosed,cold,clammy  Oesophagus- dysphagia,vomiting,drooling,haematem esis  GI-corrosion produces red/brown appearance,greyish pseudomembrane forms,burning sensation,acrid,soapy and nauseous taste.
    • Mechanism of action Hydroxide ions saponify FAs of the cell membrane Protein disruption,solubilisation Liquefaction necrosis,further penetration of alkali
    • MANAGEMENT  Decontamination of skin  Respiratory system-endotracheal intubation,cricothyrotomy,tracheostomy,oxyg en inhalation.  Demulcents-milk,egg white,lemon,barley  Assess fluid and electrolyte balance  Unbearable pain/convulsion  Corticosteroids-to prevent stricture formation  Antibiotics-if perforation seen.  Proton pump inhibitors
    • REFERENCES Fundamental of forensic medicine and toxicology,2nd edition R.Basu,pg no.391-399 Textbook for medicine and toxicology,15th edition V.V.Pillay,pg no.450-463 Forensic medicine & toxicology,2nd edn R.N.Karmakar,pg no.63-65