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14 CACHO, Patrice Dianne G.

PHARCHM 5 LEC
36 MORON, Rey Sebastian S. 4B-PH

CAUSTICS/CORROSIVE

I. BACKGROUND - ingestion causes more damage to the stomach than


CAUSTICS/CORROSIVES the esophagus
- a group of chemicals with the capacity to cause tissue - ingestion can cause a black bloody diarrhea, epigastric
injury on contact by a chemical reaction pain and esophageal strictures
- corrosives refer to acids while caustics are alkalis - commonly-used examples include hydrochloric acid,
- classified to two major categories: acids and alkalis sulphuric acid, and nitric acid

ACIDS ALKALIS
- strong acids with a pH ≤ 2 - strong bases with a pH ≥ 11.5
-  pH,  corrosive effect - esophagus is more severely affected than the stomach
- however, there are some substances like lemon juice - ingestion can cause thick and slimy vomit with blood
which are not corrosive despite the low pH - commonly-used examples include sodium hydroxide
- other factors include molarity, concentration, and and sodium hypochlorite
affinity for hydroxyl ions

AGENT DESCRIPTION USES FATAL DOSE


ACIDS
Hydrochloric acid colorless fuming liquid metal cleaner, drain 30 to 40 mL
(muriatic acid, spirit of yellow color upon exposure to air cleaner, laboratory reagent
salts) water solubility causes the irritating sensation in
the nose and the upper respiratory passages
higher ventilation may cause deeper
penetration in the mucosa of the respiratory
passages
Sulfuric acid heavy, oily, colorless, odourless, non-fuming electrolyte for storage 20 to 30 mL
(oil of vitriol, oleum, liquid batteries, used in 3.5 mL (some cases
battery acid) hygroscopic and reacts violently with water processing leather, fur, have report death of
giving off intense heat and food, laboratory ingestion as little as
formed through the photo oxidation of sulfur reagent this volume)
dioxide to sulfur trioxide and subsequent to
water, a component found in acid rain
Nitric acid colorless or yellow fuming liquid with an acrid used in glassblowing, 20 to 30 mL
(aqua fortis, azotic acid, odor engraving and
engraver’s acid) electroplating, farming,
welding, fire fighting and
industrial chemistry
ALKALI
Sodium hydroxide white crystalline, odorless solid drain cleaner, oven 10 to 15 g
(liquid sosa, caustic hygroscopic cleaner
soda)
Sodium hypochlorite greenish-yellow liquid household bleach 10 to 15 g
(bleach)

II. CHEMISTRY

Most acids are characterized by the presence of


hydrogen ions while most alkalis contain a hydroxide ion in
their structure.
Hydrochloric acid Sulfuric acid Nitric acid
- oral feeds depend on the degree of damage as
assessed by endoscopy
 Grade I (mild) - oral feeding on the first
Sodium hydroxide Sodium hypochlorite day
 Grade II (moderate) - liquid ingestion
III. MECHANISM OF TOXICITY after 48 - 72 hours
 Grade III (severe) - jejunostomy tube
Acids feedings after 48 - 72 hours
- cause tissue injury through coagulation necrosis - emergency laparotomy is mandatory if there is
perforation or peritonitis
- hydrogen ions dessicate or denaturate epithelial
tissues producing an eschar (dry scab) which tends
V. RELATED POISONS
to self-limit further damage which leads to edema,
erythema, mucosal sloughing, ulceration and
Carbolic Acid/ - phenol
necrosis of tissuses
Carboxylic Acid
- disinfectant with aromatic odor or
Alkalis “hospital odor”
- cause tissue injury through liquefactive necrosis - considered to be a mild corrosive
- liquefaction necrosis occurs through protein - toxic effects include CNS depression,
dissolution and fat saponification metabolic acidosis and renal damage
- hydroxide ions (OH-) react with tissue collagen, - treatment includes skin irrigation to
causing it to swell and shorten prevent absorption and activated
- small vessel thrombosis and heat production charcoal upon ingestion
follows
Ammonia - highly water soluble gas
- these mechanisms can lead to continuous
penetration into deeper tissues, resulting to - due to its high water solubility,
extensive damage ammonium hydroxide may form
which is an alkaline corrosive
IV. CLINICAL TOXICOLOGY - commonly used in agriculture,
Respiratory injury mining, explosives and as cleaning
- 100% oxygen agent
- Cricothyroidotomy - toxic manifestations include
Ocular injury cough, dyspnea, ocular irritations,
- irrigation with NSS, LRS, or tapwater for 15 to 30 dermal burns and even necrosis of
minutes or until pH 7.4 is achieved the skin
- ophthalmic consultation
VI. BIBLIOGRAPHY
- antibiotics
- https://www.powellfab.com/technical_information/sodium_hypoch
Epidermal injury lorite/what_is.aspx
- irrigation with NSS or tapwater for 15 to 30 minutes - https://pubchem.ncbi.nlm.nih.gov/compound/sodium_hydroxide
- non-adherent gauze and wrapping - http://onlinelibrary.wiley.com/doi/10.1002/3527600418.mb76470
- topical antibiotics and steroid 1e0024/pdf

- for deep second degree burns: topical silver - https://www.gov.uk/government/uploads/system/uploads/attachm


sulfadiazine ent_data/file/337689/hpa_hydrogen_chloride_toxicological_overv
iew_v1.pdf
Abdominal injury
- http://onlinelibrary.wiley.com/doi/10.1002/3527600418.mb76649
- make patient lie on his right side to prevent further 3e0015/pdf
absorption
- https://www.ncbi.nlm.nih.gov/books/NBK201482/
- give small amounts of water (120-240 mL for adults
- https://toxnet.nlm.nih.gov/cgi-
and 120 mL for children) bin/sis/search/a?dbs+hsdb:@term+@DOCNO+748
- avoid neutralization as it may cause exothermic - https://www.ncbi.nlm.nih.gov/books/NBK441921/
reaction which can cause more harm to the patient
- http://onlinelibrary.wiley.com/doi/10.1002/3527600418.mb13107
- induction of vomiting, stomach wash and use of 3e0012/pdf
activated charcoal is contraindicated