More Related Content
Similar to Corrosive.pdf (20)
Recently uploaded (20)
Corrosive.pdf
- 1. Classification of Poisons Mode of action Corrosives Irritants Neurotoxic Cardiotoxic Asphyxi -ants Miscellan -eous Dr Varun Pai AIMST university 1
- 2. Dr Varun Pai AIMST university 2
- 4. At the end of the topic the student will be able to Classify corrosive poisons Describe the signs , symptoms, diagnoses, treatment and postmortem appearances due to sulphuric acid, Nitric acid, Carbolic acid, oxalic acid and alkalies Dr Varun Pai AIMST university 4
- 5. Definition of a corrosive A corrosive is a substance which erodes and destroys any surface it comes in contact with Dr Varun Pai AIMST university 5
- 6. Phases seen in caustic exposure Acute inflammatory phase ( upto 7 days) : vascular thrombosis and cellular necrosis Latent granulation phase ( 1 to 2 weeks): sloughed mucosa shows fibroplasia and granulation tissue. Collagen replaces G.tissue Chronic cicatrisation phase( after 2 weeks): excessive scar tissue resulting in contractures Dr Varun Pai AIMST university 6
- 7. corrosives Strong acids Inorganic Organic Strong alkalis Dr Varun Pai AIMST university 7
- 8. Classification 1. Strong acids (A) Mineral / Inorganic acids (B) Organic acids 2. Strong alkalis hydroxides & carbonates of Na, K, Ca, ammonia Dr Varun Pai AIMST university 8
- 9. Mineral/ Inorganic acids 1. Severe local actions 2. No remote or systemic actions 3. Desiccation & Coagulation necrosis Sulphuric acid (oil of vitriol) Nitric acid (aqua fortis) Hydrochloric acid (muriatic acid) Hydrofluoric acid Boric acid Dr Varun Pai AIMST university 9
- 10. Organic acid 1. Severe systemic actions 2. Less severe local actions Carbolic acid (phenol) Oxalic acid (salt of sorrel) Formic acid Salicylic acid Dr Varun Pai AIMST university 10
- 11. Sulphuric acid Oil of vitriol . Oleum, battery acid Heavy, colourless, odourless, non-fuming, hygroscopic, oily liquid Uses Storage batteries Pipe and drain cleaners Laboratory Industry Dr Varun Pai AIMST university 11
- 12. Fatal dose: 20 to 30 ml of Conc H2 SO4 Mode of action: produces coagulation necrosis of tissue on contact Dr Varun Pai AIMST university 12
- 13. Clinical features Burning pain, intense thirst Teeth chalky white, brittle Vomiting- brown/black material ( coffee ground vomitus ) Respiratory manifestations Burnt skin ( blackish eschar formatin ) Acidemia Generalised shock Dr Varun Pai AIMST university 13
- 14. Lips are swollen and excoriated with blackish streaks present running down the angles of the mouth. Dr Varun Pai AIMST university 14
- 15. Dr Varun Pai AIMST university 15
- 16. Complications a) Perforation of GIT b) Secondary infection c) Stricture formation d) Carcinoma e) Renal failure Dr Varun Pai AIMST university 16
- 17. Diagnosis Litmus test Sodium bicarbonate drops (cloths) -bubbles Addition of barium chloride Dr Varun Pai AIMST university 17
- 18. Treatment Oral feeds, stomach wash or induction of emesis is contraindicated. Wash and the irrigate the skin copiously with saline Demulcents Respiratory distress 100% oxygen Morphine & crushed ice Dr Varun Pai AIMST university 18
- 19. Antibiotics & corticosteroids Fiber optic endoscopy Emergency laprotomy Dr Varun Pai AIMST university 19
- 20. Pm appearances Corroded areas appear brownish or blackish Stomach mucosa- wet blotting paper ( Black in color) Acids act on the columnar epithelium of the stomach The mucosal ridges are more damaged then the furrows Dr Varun Pai AIMST university 20
- 21. Inflammation, necrosis or perforation of the GI tract Dr Varun Pai AIMST university 21
- 22. Dr Varun Pai AIMST university 22
- 23. Dr Varun Pai AIMST university 23
- 24. Dr Varun Pai AIMST university 24
- 25. Dr Varun Pai AIMST university 25
- 26. Medicolegal importance -Vitriolage- example of grevious hurt. Jealous or disgruntled persons may use to disfigure enemies. blindness may occur. Death may result from shock or toxemia. The penetrating burns devitalises the tissues and predispose to infection. Scar tissue may lead to contracture Dr Varun Pai AIMST university 26
- 27. Dr Varun Pai AIMST university 27
- 28. Treatment - washing skin with water & soap - raw surface covered with some antibiotic cream -eyes should be washed with water and irrigated with1% sodium bicarbonate solution Dr Varun Pai AIMST university 28
- 29. Accidental poisoning Disposal of body : John George Haigh Dr Varun Pai AIMST university 29
- 30. Nitric acid (Syn: Aqua Fortis , engravers acid ) Colourless or yellow, Fuming liquid, pungent odour Uses Engraving Electroplating Fertilizers Metal refineries Dr Varun Pai AIMST university 30
- 31. Xanthoproteic reaction -Yellow stains on clothing and tissues and crowns of teeth Reacts with organic acid to produce trinitrophenol Dr Varun Pai AIMST university 31
- 32. Signs and symptoms Inhalation of fumes can produce lacrimation , coughing & dysnoea Abdominal distension Perforation of the GIT is less common Dr Varun Pai AIMST university 32
- 33. PM appearance- corroded areas of skin and mucous membrane appear yellowish Perforation is not as common as in cases of H2SO4 Treatment is same as in cases of H2SO4. Dr Varun Pai AIMST university 33
- 34. Organic acids weaker in corrosive action Absorbed in to circulation- both systemic & local actions Carbolic acid (Phenol) Oxalic acid Salicylic acid Formic acid Dr Varun Pai AIMST university 34
- 35. Carbolic acid (Phenol) Colorless, needlelike crystals turns pink & liquefy Commercial phenol- brownish liquid with several impurities with hospital odour Derivatives- cresol, coal tar, thymol, tannic acid Dr Varun Pai AIMST university 35
- 36. Uses Antiseptic and disinfectants Preservative in injectable medications Face peel in plastic surgery Dr Varun Pai AIMST university 36
- 37. Signs and symptoms Acute poisoning ( carbolism ) Local: skin or mucosal contact: hardening and whitish discoloration with burning pain, tingling, numbness, Dr Varun Pai AIMST university 37
- 38. Systemic poisoning: GIT: burning pain, vomiting CNS: vertigo, convulsions, coma. Pupils: constricted CVS: tacycardia, hypotension, arrythmias RS: tachypnoea, bronchospasm, pulmonary edema Blood: hemolysis, methhemoglobinaemia Dr Varun Pai AIMST university 38
- 39. Metabolic : hypothermia, with metabolic acidosis Hepatorenal: oliguria with scanty urine which turns greenish or brownish on exposure to air this is due to metabolities hydroquinone and pyracatechol Also called as carboluria Dr Varun Pai AIMST university 39
- 40. Pm appearance Distinct odour of phenol at mouth and stomach contents Corroded area brownish or whitish Stomach mucosa pale, hardened, leathery Cerebral & pulmonary oedema Congestion of internal organs Dr Varun Pai AIMST university 40
- 41. Treatment Stomach wash thick, hard & leathery consistency Demulcents Sodium bicarbonate IV Methylene blue IV Haemodialysis Supportive measures Dr Varun Pai AIMST university 41
- 42. Medicolegal importance Accidental poisoning Suicidal deaths- rare Homicidal- extremely rare Dr Varun Pai AIMST university 42
- 43. Oxalic acid ( Syn: salt of sorrel, acid of sugar) Prismatic crystals similar to magnesium & zinc sulphates Uses ink & rust remover - Bleaching agent & industry Dr Varun Pai AIMST university 43
- 44. Mechanism of action local- do not lose poisonous properties when diluted Combines with serum calcium & produce features of tetany Forms calcium oxalate and it is precipitated and accumulated in the liver, kidneys, heart, lungs and is excreted in urine Dr Varun Pai AIMST university 44
- 45. Clinical features Local: whitish or yellowish corrosion of the skin The mucosa is referred to as scalded appearance Systemic: vomiting and diarrhoea Signs and symptoms of tetany Dr Varun Pai AIMST university 45
- 46. Diagnosis Demonstration of urinary oxalate crystals Monohydrates( prism or needle like) Dihydrates ( tent or envelope shaped) Measurement of oxalic acid in urine by colorimetry Dr Varun Pai AIMST university 46
- 47. Treatment Stomach wash lime water, chalk suspension, ca gluconate solution. Calcium gluconate- IV (10ml of a 10% solution) Demulcents Parathyroid extract-100 units IM Dr Varun Pai AIMST university 47
- 48. PM APPEARANCE Corrosion of mucosa- whitish or yellowish Scalded mucosa of the GI tract, especially stomach Kidney- necrosis & hyaline degeneration of tubules Dr Varun Pai AIMST university 48
- 49. Dr Varun Pai AIMST university 49
- 50. Alkalies Ammonium hydroxide: paint, oil and dirt remover Sodium hydroxide: drain cleaner, oven cleaner Potassium hydroxide: drain cleaners, hearing aid batteries Sodium hypochlorite: household bleach Sodium carbonate: washing soda Dr Varun Pai AIMST university 50
- 51. Mode of action Produce liquefaction necrosis Extensive penetrating damage because of saponification of fats and solubility of proteins Oesophogus more affected Alkalis are more prone to cause perforation than acids Dr Varun Pai AIMST university 51
- 52. Clinical features Corrosion of the GI mucosa with pseudomembrane formation Oesophagus is commonly affectes resulting in dysphagia, vomiting, drooling and stridor Abdominal pain, diarrhea, tenesmus Greyish soapy necrotic areas on the skin Eye involvement Dr Varun Pai AIMST university 52
- 53. Diagnosis In stomach contents White slimy lumps, flakes and granules Turns litmus paper blue Soapy and slimy feeling when touched sharp penetrating odour in case of ammonia Dr Varun Pai AIMST university 53