Corrosives2 BY DR. FAIZA11111111111.pptx

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1. CORROSIVE POISONING By : Dr. FAIZA MEMON

2. DEFINITION A Corrosive poison fixes, destroy and erodes the surface with which it comes in contact

3. INTRODUCTION Corrosives are defined as solids or liquids that, by chemical action will cause severe damage when in contact with living tissue or they can destroy other goods. The corrosives are the second most commonly used group of hazardous materials and the only group that is more commonly encountered is the flammable liquids. EXAMPLE: Sulfuric Acid. They are used in every thing from flashlight and car batteries, to toilet bowl cleaners; from disinfectants, to rust- proofing agents.

4. CLASSIFICATION ACIDS ALKALIES MINERAL ACIDS ORGANIC ACIDS Sulfuric acid Oxalic acid Ammonia Nitri c acid Carbolic acid Caustic potash & Soda Hydrochloric acid Picric acid Ammonium carbonate & hydroxide Salicylic acid Potassium & Sodium carbonate Acetic acid Potassium Permanganate

5. MECHANISM OF ACTION They cause Because of its affinity with water it destroys the tissues by rapid dehydration, this is accompanied by a considerable generation of heat and tissues are severally scalded. Coagulates the tissue proteins with protein dissolution, collagen destruction & cell membrane emulsification. Convert Hb to Haematin by action of acid on hemoglobin (dark color is due to acid haematin).

6. GENERAL SYMPTOMS AND SIGNS OF CORROSIVE POISONING Onset of symptoms is immediate. Burning pain and sensation in mouth, throat, esophagus and stomach & thus abdominal pain. Intense thirst Pain and difficulty in swallowing Vomiting (blood stained). Scanty urine and is acidic. Constipation with acids and diarrhea with alkalis. Lips and chin corroded. Neurogenic shock due to pain Skin is cold and clammy and pupils are dilated.

7. SITES LIKELY TO BE EFFECTED BY CORROSIVES 1. Skin – Face - Dermal: Staining of skin with burning pain. - Ocular: conjunctivitis, corneal destruction. lacrimation, photophobia and pain. 2. Mouth & throat 3. Upper alimentary tract 4. Respiratory tract - inhalation: Bronchial irritation, pulmonary edema, frothy sputum, moist rales, hypotension, hemoptysis & dyspnea.

8. EFFECTS OF CORROSIVES EARLY EFFECTS: Pain and shock. Vomiting. Dyspnea due to respiratory obstruction from laryngeal edema. LATE EFFECTS: Perforation of stomach. Pulmonary edema. Bronchopneumonia.

9. DELAYED EFFECTS: Esophageal or pyloric stricture. Laryngeal stricture. Pulmonary fibrosis.

10. Fatal Dose: 10-15ml (30ml). Fatal Period: 12 to 24 hours. Cause of death: - instantaneous => shock - early => suffocation within 24hrs of perforation . - after few days => gastric inflammation - delayed => exhaustion, stricture of esophagus & secondary pneumonia.

11. MANAGEMENT OF CORROSIVE POISONING Essentials: D etermine relative strength of the product (concentrated or dilute) Do not attempt neutralization, induced emesis, gastric lavage or activated charcoal are all contraindicated. give plenty of water to the patient. bicarbonates are contraindicated as they yield CO 2 which will result in perforation.

12. MANAGEMENT OF CORROSIVE POISONING - The oropharynx must be carefully examined but normal findings do not exclude significant injury. Upper gastrointestinal endoscopy is the best guide for prognosis and subsequent management. Signs and symptoms do not always correlate with the severity of injury.

13. GENERAL TREATMENT OF CORROSIVE POISONING 1) In cases of acids, it should be immediately diluted & neutralized by administration of water. 2) Give demulcents, drinks such as barley water, olive oil and melted butter. 3) Give corticosteroids by mouth, or injection to prevent shock and esophageal stricture.

14. 4) Give analgesics like morphine or pethidine for pain. 5) Dextrose saline drips I/V for dehydration and thirst to correct electrolyte imbalance. 6) Oxygen and artificial respiration may be needed. 7) Tracheotomy may be done if there is suffocation due to acute edema of the glottis.

15. ALKALIS Like acids alkalis act as corrosive poisons when administered in a concentrated form but act as irritant poison when dilute. SIGNS & SYMPTOMS : 1) The taste is nauseous & soapy. 2) Purging is a frequent symptom accompanied with severe pain & straining. The motions consist of stringy mucous mixed with blood. TREATMENT: Neutralize by weak acids chiefly vegetables, acetic acid(vinegar), citric acid(lemon juice) mixed with large quantity of water. Morphine for pain.

16. POSTMORTEM APPEARANCES Signs of corrosions. Externally, the lips may be burnt and trickles mark may be found running from the mouth to the chin, neck, and chest. Internally, localized patches to extensive areas, particularly in stomach. Perforation in the stomach is common in sulphuric acid.

17. MEDICOLEGAL ASPECTS Attempted Suicide  with corrosives is not seen now owing largely due to the use of other less painful substance like barbiturates and synthetic narcotics and organophosphate compounds. Corrosives are rarely used for homicide owing to their painful action. Corrosives usually thrown on the face out of jealousy or in fits of rage, called vitrolage. They cause severe injury even death from accidental spilling.

18. VITROLAGE

19. Acid throwing, also called an acid attack or vitrolage A form of violent, criminal assault, defined as the premeditated act of throwing acid. Sulfuric acid (oil of vitriol), hydrochloric acid, nitric acid, hydrofluoric acid or other similar, dangerous, corrosives chemical substances, onto the body of another human being. With the intention to disfigure or kill. Perpetrators of these attacks throw acid at their victims, usually at their faces. -burning them, melting and damaging skin tissues -Often exposing and sometimes dissolving even the bones

20. Treatment Immediate washing with water and soap Wash with a dilute solution of sodium or potassium bicarbonate. Apply thick paste or magnesium oxide or carbonate Apply antibiotic- superficial & oral – reduce chance of infection. Skin grafting may be needed Eyes- wash with water- 1% solution of sodium bicarbonate Use olive oil drops. Eye drops containing antibiotics.