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The strong mineral acids exert primarily a local corrosive effect on the skin and mucous membranes. Symptoms include 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; and shock. Severe systemic metabolic acidosis may occur both as a result of cellular injury and from systemic absorption of the acid.

Severe deep destructive tissue damage may occur after exposure to hydrofluoric acid because of the penetrating and highly toxic fluoride ion. Systemic hypocalcemia and hyperkalemia may also occur after fluoride absorption, even following skin exposure.

Inhalation of volatile acids, fumes, or gases such as chlorine, fluorine, bromine, or iodine causes severe irritation of the throat and larynx and may cause upper airway obstruction and noncardiogenic pulmonary edema.

TREATMENT

A. Ingestion

Dilute immediately by giving a glass (4–8 oz) of water to drink. Do not give bicarbonate or other neutralizing agents, and do not induce vomiting. Some experts recommend immediate cautious placement of a small flexible gastric tube and removal of stomach contents followed by lavage, particularly if the corrosive is a liquid or has important systemic toxicity.

In symptomatic patients, perform flexible endoscopic esophagoscopy to determine the presence and extent of injury. CT scan or plain radiographs of the chest and abdomen may also reveal the extent of injury. Perforation, peritonitis, and major bleeding are indications for surgery.

B. 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 (prepared by adding 3.5 g calcium gluconate to 5 oz of water-soluble surgical lubricant, eg, K-Y Jelly); then arrange immediate consultation with a plastic surgeon or other specialist. 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).

C. 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.

D. 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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