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Key Features

  • Strong mineral acids exert primarily a local corrosive effect on the skin and mucous membranes

Clinical Findings

  • Severe pain in the throat and upper gastrointestinal tract

  • Bloody vomitus

  • Difficulty in swallowing, breathing, and speaking

  • Discoloration and destruction of skin and mucous membranes in and around the mouth

  • Shock

  • Severe irritation of the throat and larynx, upper airway obstruction, and noncardiogenic pulmonary edema due to inhalation of volatile acids, fumes, or gases

  • Severe systemic metabolic acidosis may occur as a result of cellular injury and systemic absorption of the acid

  • After exposure to hydrofluoric acid

    • Severe deep destructive tissue damage may occur because of the penetrating and highly toxic fluoride ion

    • Systemic hypocalcemia and hyperkalemia may also occur, even following skin exposure

Diagnosis

  • CT scan or plain radiographs of the chest and abdomen may also reveal the extent of injury caused by ingestion

Treatment

  • Ingestion

    • Dilute immediately by giving 4–8 oz of water to drink

    • Do not give bicarbonate or other neutralizing agents

    • Do not induce vomiting

    • If the corrosive is a liquid or has important systemic toxicity, some experts recommend immediate cautious placement of a small flexible gastric tube and removal of stomach contents followed by lavage

    • In symptomatic patients, perform flexible endoscopic esophagoscopy to determine the presence and extent of injury

    • Perforation, peritonitis, and major bleeding are indications for surgery

  • Skin contact

    • Flood with water for 15 minutes

    • Use no chemical antidotes; the heat of the reaction may cause additional injury

    • For hydrofluoric acid burns, soak the affected area in benzalkonium chloride solution or apply 2.5% calcium gluconate gel

    • Binding of the fluoride ion may be achieved by injecting 0.5 mL of 5% calcium gluconate per square centimeter under the burned area

    • Caution: Do not use calcium chloride

    • Use of a Bier-block technique or intra-arterial infusion of calcium is sometimes required for extensive burns or those involving the nail bed

    • Consult with a hand surgeon or poison control center (1-800-222-1222)

  • Eye contact

    • Anesthetize the conjunctiva and corneal surfaces with topical local anesthetic drops (eg, proparacaine)

    • Flood with water for 15 minutes, holding the eyelids open

    • Check pH with pH 6.0–8.0 test paper, and repeat irrigation, using 0.9% saline, until pH is near 7.0

    • Check for corneal damage with fluorescein and slit lamp examination

    • Consult an ophthalmologist about further treatment

  • Inhalation

    • Remove from further exposure to fumes or gas

    • Check skin and clothing

    • Observe for and treat chemical pneumonitis or pulmonary edema

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