Acids, Corrosive

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

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

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

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