Corrosive Poisons

DR.ZAKIR HOSSAIN
MBBS,DFM(BSMMU)
Department of Forensic Medicine &
Toxicology
 Definition

 A corrosive poison that fixes, destroys and

erodes the surface with which it comes in
contact.
 Classification

They are classified two major groups

A. Acids & B. Alkalis
A. Acids
1. Mineral acids.
2. Organic acids.
3. Vegetable acids.
 Contd

1. Mineral acids (Inorganic Acid)

Sulphuric acid.
Nitric acid.
Hydrochloric acid .
2. Organic acids
Oxalic acid.
Carbolic acid..
Salicylic acid
 Contd
3. Vegetable acids
Hydrocyanic acid.
Citric acid .
Acetic acid.
 Contd
2. Alkalis
Ammonia
Calcium hydroxide
Caustic potash & Soda
Ammonium hydroxide
 Mode of action
(Mineral acids & alkalis)

 Extraction of water from tissues

 Coagulation of cellular proteins
 Conversion of hemoglobin into
hematin.
 Mineral acids: produce coagulative
necrosis.
 Alkalis: produce liquefactive necrosis.

So Alkali is more dangerous than acid

because they have more penetration
capacity to underlying tissue and leads to
extensive damage.
 Concentrated acid has corroding effects specially
on Skin and GIT.
 No remote systemic action on exception of shock
except Carbolic Acid
 In diluted form they act as irritants and produce
irritant effects
 Well Diluted acids and alkalis are act as stimulant.
 Only strong acids and alkalis act as corrosive
poison
 Difference
Effect Alkali Acid
Injury Severe Less severe
Necrosis Liquefactive Coagulative
Burns Deep 2nd degree
Edema Marked Mild
Eschar Soft, edematous, Hard
translucent
Charring Not seen Seen
 Signs and Symptoms

Onset : immediate
 Symptoms:
 Burning sensations (mouth, throat, esophagus,
stomach)
 Intense thirst- an unquenchable thirst
 Dysphagia
 Hematemesis
 Contd
 Vomitus is either acidic or alkaline
depending on substance swallowed.
 Mouth & lips are corroded
 Tongue : swollen
 Teeth: chalky white - Sulphuric acid
poisoning, yellowish - Nitric acid poisoning
 Constipation & scanty urine with corrosive
acids
 Bloody diarrhea with alkalis
 CAUSE OF DEATH
Immediate
 Shock

 Suffocation: edema or spasm of glottis

 Gastric perforation

Delayed (quantity of poison -small)

 Hypostatic pneumonia

 Esophageal stricture :(emaciation and malnutrition)

 Secondary infections

 Incurable dyspepsia due to destruction of coats of

stomach
 Treatment

1. Stomach tube and emetics are

contraindicated except Carbolic Acid because
it produce the mucosal wall of GIT HARD &
LEATHERY.
2. Strong alkalis are not used for
neutralization of acid poisoning as well as
strong acid are used for alkali neutralization if
so reaction will produce heat(Exothermic
Reaction)which leads to perforation.
 Contd
3. Morphine: to relieve pain
4. Ice: to relieve thirst
5. IV fluids: to compensate fluid loss
6. Steroids: -Shock
-To prevent esophageal strictures
7. Keep the airway patent
-Tracheostomy: Acute edema of glottis
-Poisoning by ammonia vapors give oxygen
8. Keep the patient NPO
9. Nutrient substances are given by IV route for
about a week.
10. Try liquids, soft food and finally a regular
diet.
11. Antibiotics to prevent infection.
 POSTMORTEM APPEARANCE

Depends on:
 Quantity
 Strength of acid
 Time the patient survives after intake of acid
 Contd
The parts come in contact with especially,

lips, mouth, throat, chin, angle of mouth,

hands, etc. become corroded, and evidence

on the clothing, furniture etc. when spilt over

them.
 Contd
 The internal findings are restricted to the upper
gastrointestinal and respiratory tract and these
are:
 Pharynx and esophagus show inflammatory
changes bleeding & edema
 Stomach is converted into a boggy, soft black
mass which breaks on touch Contents- Tarry black
or brown.
Difference Between Flame burn
and Acid burn
 In Acid burn tailing will be below
and in flame burn tailing will be
above the contact point.
 MEDICO LEGAL ASPECTS
1. Attempted Suicides:
Not seen now a days due to use of less painful
substances like barbiturates, narcotics & organo-
phosphorous compounds.
2. For Homicides:
Rarely; because of taste, immediate local action .
3. Vitrolage :Throwing of a corrosive on face for
jealousy or revenge.
4. Accidental poisoning may occur when they
taken by mistaken for other substances.
5. They are occasionally used inside vagina of a
women as a punishment for adultery.
Sulphuric Acid(H2SO4)
 Properties

 Sulfuric acid: It is a colorless, odorless

heavy, hygroscopic, non fuming, oily liquid
having charring or carbonizing properties to
organic substances.
 Others name: 1. Oil of Vitriol.
2. Battery acid.
In our department it is blackish brown in
colour because it is a commercial
preparation and impurities.

Sulphuric acid impure by lead sulphate,

arsenic, nitric acid, lower oxaides of nitrate.
 SIGNS AND SYMPTOMS
 Chemical burns over the face and adjoining parts which
come in contact with it
 The burn area looks blackish due to charring of the tissue,
later on it becomes hard & scared. (H2S04 has carbonizing
property).
 Lips are swollen and excoriated
 Teeth become chalky white (due to calcium-sulphate
formation)
 Tongue become swollen and black.
 Corrosion of mucous membrane of mouth throat esophagus
Fatal dose: 5-10 ml.
Fatal
period :12-24 hrs.
 Complications after ingestion of
sulphuric acid

Acute : Upper airway obstruction and injury

GI hemorrhage
Esophageal and gastric perforation
Sepsis
Tracheo-bronchial necrosis
Obstructive lung injury
Chronic: Esophageal obstruction.
Pyloric stenosis.
Vocal cord paralysis with airway obstruction.
 Cause of death
Immediate:
 Shock
 Suffocation: edema or spasm of glottis
 Gastric perforation
Delayed (quantity of poison small:)
 Hypostatic pneumonia
 Esophageal stricture :(emaciation and
malnutrition)
 Secondary infections
 Incurable dyspepsia due to destruction of coats
What we look if a person suicide with
ingestion of sulphuric acid ??
 Dribbling mark of H2SO4 from angle of the
mouth.
 Swelling and corrosion of the mucous
membrane of lips.
 Teeth become chalky white.
 Tongue become swollen, sodden, black.
 VITRIOLAGE
 Throwing of strong corrosives specially concentrated
sulphuric acid on the face of a person with an
intention to produce permanent disfiguration out of
jealousy, revenge, or enmity is called vitriolage
 These fluids are usually thrown on face for
destroying vision or causing facial disfigurement.
 Results in Grievous Hurt.
 Contd
 Sulphuric acid - Commonly used.
 Causes chemical burns
 Burns are painless, penetrating
 Repair is slow
 Scar causes contractures.
 Death may result from shock & toxemia if
extensive areas are involved.
Motive:
It is done out of jealousy, enmity,
revenge.
To disfigure the face of the victim after
refusal of sweet proposal.
 Complications
 Disfiguration of face.
 Destruction of eyes with permanent loss of
eyesight.
 Ulceration and resultant scar formation of
affected area of body.
 Scar formation and which if is near a joint may
restrict functions of joint grossly.
 Death.
 Medicolegal importants

 It causes Grievous hurt.

 But if the victim dies it is amount to
homicide.

Grievous hurt caused by H2SO4:

No: 1,2,3,5,6,8.
 TREATMENT

 Wash the corrosive acid with large amount of

water and soap or dilute solution of sodium or
potassium bicarbonate.
 Thick paste of magnesium oxide is applied
 Raw surface - covered with antibiotic ointment
 Eyes: Washed with large amount of water and
irrigated by 1 % solution of sodium bicarbonate and
a few drops of olive oil or castor oil are instilled into
eyes.
 Eye drops containing steroids and antibiotics are
helpful .
 Punishment of Vitriolage
Death of a victim: Death sentence.
Grievous hurt: life long imprisonment.
Simple hurt: 10 -14 years.
No hurt but just acid thrown towards victim:
7- 10 years.
THANKS