Acids, Corrosive

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 may cause upper airway obstruction and noncardiogenic pulmonary edema due to inhalation of

  • Volatile acids

  • Fumes

  • Gases, such as

    • Chlorine

    • Fluorine

    • Bromine

    • Iodine

• 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

• If acid has been ingested,

  • Perform flexible endoscopic esophagoscopy in symptomatic patients 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 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

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

  • Use of corticosteroids may be indicated for the prevention of stricture formation in select patient populations but is controversial

• 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, 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