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CORROSIVE POISONS

CORROSIVE: The corrosive have a local chemical action of corroding and destroying the tissues they come in contact with.ACIDS: are hydrogen containing substances that, on dissociation in water, produce hydronium ions. they produce the coagulation necrosis of tissues by the precipitation of poison.ALKALIES: are substances which neutralize acids.INORGANIC ACIDS: are mineral acids used as reagents. Eg- Sulphuric acid, Nitric Acid, Hydrocholric acid.ORGANIC ACID: are carbon compounds, thus have better absorption and display prominent systemic effects.

6.EFFECTS: when corrosive agents come in contact with skin, body 3 stages.Stage I: intense inflammatory reaction first 4-7days.Stage II : granulation stage: fibroplasia, formation of collagen, starts during 2nd-3rd week. Chance of perforation tissues are weak.Stage III: excessive formation of scar tissue- stricture.7. SUPPORTIVE THERAPY:Tracheotomy: suffocation with involvement of larynx.Oxygen and ventilatory supportPerforation needs emergency surgery.Excoriation : treated as burns.Injury to eye: moistening with plenty of water/saline.Ingestion of strong acids: shock with I.V infusion & supportive therapy, pain controlled with morphine.To prevent stricture of the esophagus; corticosteroid therapy, &wax candle

SULPHURIC ACID

Pure is colorless, heavy, hygroscopic, oily liquid and gives out no fumes when exposed to air. With water, it gives out a large amount of heat.Commercial sulphuric acid: contains impurities is brown in color ( Industry chemicals, battery and fertilzers manufacturing.Mode of action : it has high affinity of water,Draws out water from the tissues and destroys them by rapid dehydrationGives out large amount of heat necrosis of tissues. It burns & blackens skin, cloth, wood or any organic matter.

CLINICAL FEATURES: General symptom: burning pain in mouth, throat, esophagus and stomach with brownish or blood stained vomit.LIPS: swollen, abrased and brown or black streaks can be found.TEETH: chalky white color, rough and deprived of their polish.INTENSE THIRST:VOICE: hoarse and rough inflammation of the larynx.HYPERSALIVATION: may seen second or third day.FATAL DOSE- 5-10mlFATAL PERIOD: 18-24 HOURS.TONGUE: swollen, covered with white coating and S, - darker/ brown in color.

CAUSES OF DEATH:Suffocation: Death may occur instantaneously edema, spasmodic closure of glottis by the acid . shock and circulatory failure: death may occur in 24 hours.Peritonitis: death may be prolonged for weeks or months- secondary to esophageal/ pyloric stenosis or the perforation of stomach.

VITRIOL / ACID THROWING (VITRIOLAGE):

Sometimes, envious people use vitriol or strong sulphuric acid to disfigure the face.Local effects: slight burning pain, the corrosion of tissues and formation of brownish scars which leave permanent scars.Common complications: Conjunctival edema, corneal destruction or blindness. Death may also occur by severe burns.

POST-MORTEM APPEARANCE:1.Lips and surrounding skin- brownish or black corroded spots- mucus also will be in dark brown.2. Stomach: (if Perforated blackening is seen with the escape gastric contents into peritoneal cavity)(if not perforated stomach will be contracted & collapsed, contents- dark brown in color with mucus and blood.)3. Liver and Kidneys shows fatty changes.4. Blood vessels : may showed clotted blood.MEDICO-LEGAL ASPECTS: Suicidal, homicidal, accidental & vitriolage.

NITRIC ACIDPROPERTIES:Is clear & colorless liquid, powerful oxidizing agent which dissolves all metals except gold and platinum. Commercial nitric acid varies from yellow to deep red ( oxides of nitrogen)USES: used in arts and manufacturing, for cleaning nickel ornaments, separating gold from other metals, for the preparation of explosives, coloring agent & as a fertilizers.

CLINICAL FEATURES:Lips, tongue & mucous membrane of the mouth soften and became white, but later yellow by the action of acid with organic matters.Teeth: yellow with partial destruction of enamel.Skin and cloth: yellow turn orangeVomitus: yellowish brown due to blood colour.Abdomen, markedly distended and tender gaseous belching is more.Urine: oliguria, anuria, albuminuria & casts.Lock jaw & insensibility : frequently found.Inhalation of fumes : irritation of eyes, lacrimation, photophobia, cough and breathlessness.Fatal dose: 5-15mlFatal period: 12-24 hours on an averageCauses of death : suffocation, Pul edema.

POST MORTEM APPEARANCE:Skin and mucous membrane of mouth and lips; eroded and yellow in color.Stomach: mucous membrane is greenish, wall is soft, ulcerated and may perforate.Corrosion of duodenum may found.If death was due to inhalation of fumes means- larynx, trachea and bronchial tubes are congested.MEDICO-LEGAL ASPECTS:

HYDROCHLORIC ACIDIt is colorless gas with irritating oddour, extremely soluble in water.Commercial acid- HCL gas in water gives fumes in damp air with yellow color.Produces dense white vapors with ammoniaUSES: used in industry for preparing chlorine,For dissolving metals & for medicinal purposesFor erasing the writings.

CLINICAL FEATURES: 1.Less active than other inorganic acids, - symptoms will be mild .2.Does not stain the skin or mucous membrane but stains dark clothes reddish brown.3. Cause salivation, convulsion, delirium or paralysis of limbs.4, when inhaled: Severe irritation of air passage with spasm of glottis.Chronic exposure cause conjunctivitis, corneal ulcer, pharyngitis, laryngitis & bronchitis.

POST-MORTEM APPEARANCE:Mucous membrane- ash grey/ black in color.Stomach: wall is red.Mucosa- brownish leathery and firm.Perforation may rarely occur.MEDICO-LEGAL ASPECTS:Accidental & suicidal cases are common but homicidal rare.

OXALIC ACIDProperties:Colorless, transparent, prismatic crystals, sour taste, strongly acidic: sublimes after heating: soluble in water and alcohol.Heated with sulphuric acid, it splits up into CO2, CO & water.Uses:White cloth printing, manufacture straw hats, cleaning brass and copper articles & wooden surfaces.Bleaching powder for erasing writing and signatures from paper and printed documents

CLINICAL FEATURES

LOCAL ACTION:As a corrosiveAs a irritantProlonged contact with skinGIT: sour acid taste, thirst, pain and burning in mouth, throat, stomach.Intense vomiting greenish brown, black or ground coffee due to blood and mucus.

SYSTEMIC ACTION:Systemic absorption by precipitating ionized calcium hypocalcemia.Insoluble calcium oxalate accumulates in kidneys, liver, heart, lungs and blood and is excreted in the urine.Oliguria diuresis, albuminuria with hyaline casts leading to acute renal failure.Numbness of limbsFeeble, irregular & slow pulseShallow, gasping & slow pulseTetany, cramps , convulsion, lock-jaw, shock,

3. Fatal Dose: 15gm4. Fatal period: 1-2 hours.TRAETMENT: Neutralization of acidI.V calcium gluconateGastric lavage with 1% calcium gluconate solution.Castor oil with purgative.Renal blood flow maintained by the I.V infusion of glucose.

POST- MORTEM APPEARANCE:A. Oxalic acid taken in concentrated form:Signs of corrosion, their mucous membrane are white, wrinkled and can easily detached from underlying tissue.STOMACH: Contains dark brown, thick and lumpy liquid formation of acid hematin.Blood vessels dark brown/black streaks seen Deposits of calciumPerforation.Intestines: the upper part of duodenum affected.Kidneys: congested and tubules are loaded with crystals- tubular necrosis.

B. If oxalic acid was dilute : Local irritation may be found redness, congestion and the inflammation of mucous membrane.Sometimes the congestion of lungs, liver, kidneys and brain.MEDICO LEGAL ASPECTS: Accidental poisoning : common having been swallowed by mistake as a saline purgative of magnesium sulphate.Suicidal and homicidal are rare.

CARBOLIC ACIDProperties: Pure acid short, needle shaped crystals which turn pink on exposure to light & melt in mist air, colorless.It has carbolic odor & a sweetish pungent taste.Solubility : insoluble in liquid paraffin & soluble in water, alcohol, ether glycerine & volatile oils.Commercial carbolic acid Phenol camphorCrude carbolic acidUses : antiseptic, disinfectant & presevative

CLINICAL FEATURES: poisoning by carbolic acid _ carbolism.1.Mode of action: In concentrated form- corrosive, when applied to skin, it causes a burning sensation- tingling sensation & numbness. 2. Routes of excretion: urine, saliva, skin and stomach.3. Symptoms: intense thirst and burning sensation in mouth, throat and stomach. Vomiting of frothy mucus.4. Causes of death: failure of respiratory center. Shock and circulatory collapse. Renal failure.5. Fatal dose: 2gm6.Fatal period: 3-4 hours.

POST-MORTEM APPERANCE:Dark brown abrasion on the angles of the mouth and the chin.The mucus membrane of lips, mouth and throat is congested, swollen.The mucous membrane of esophagus is tough, grey and arranged in longitudinal folds.STOMACH: brown, leathery with hemorrhagic spots and folds. contains reddish fluid mixed with mucus and pieces of epithelium with the odour of carbolic acid.KIDNEYS shows haemorrhagic nepritis.LUNGS congested and edematous.BRAIN CongestedBLOOD dark, semi fluid / partially coagulated.MEDICO-LEGAL IMPORTANCE: accidental and suicidal poisoning.Homicidal rare due to odour and taste.

SALICYLIC ACIDOTHER PREPARATIONS/ NAMESUSES1. Methyl salicylate ( oil of wintergreen)Used locally as anti-fungalAs the irritant and a counter irritant2. Aspirin (acetyl salicylic acid)i. Antipyretic, analgesic, anti-rheumatic & anti-inflammatory agent.3. Sodium salicylateAnti-rheumatic and anti-inflammatory

CLINCAL FEATURES:Burning pain in throat and epigastrium.Difficulty in swallowing, thirst, nausea, vomiting and diarrhoea.Systemic toxicity: Headache, dizziness, buzzing in ear and deafness.Vomiting, dehydration, generalized weakness & mental changes.Severe acid-base imbalance.Renal functions and carbohydrate disturbances.Hyperpyrexia and encephalopathy.Death may occur from: cardiac and respiratory failure.Chronic poisoning SALICYLISM Loss of blood in stools. Loss of apetite, GIT disturbances, Renal impairment5. Fatal dose : 10gm.6. Fatal Period : 1-4 days.

TREATMENT:Gastric lavage Activated charcoalPurgativesAdvanced life support measuresOxygenation for pul.edemaVit K for Hypoprothrobinaemia.Ventilatory supportInjection ACTH as a life-saving therapy.POSTMORTEM APEARANCEMEDICO-LEGAL ASPECTS: Accidental poisoning from overdose administration.

ALKALIESIn concentrated form act as a corrosive poison, in a dilute form they act as an irritant poison.Concentrated alkalies are more dangerous than acids- esophageal burns and stricture.With fats soaps, with protein protinates.

MAJOR CORROSIVE ALKALIES1.AMMONIA: with water forms a strong solution of ammonia- liquor ammoniae fortis. Colorless liquid very pungent odour.The gas used as refrigerant and a fertilizer.2. POTASSIUM HYDROXIDE: Soapy to touch, rapidly absorbs CO2 from air and soluble in water.3. SODIUM HYDOXIDE: occurs as white mass.4. AMMONIUM CARBONATE- translucent, hard, crystalline mass, water soluble.5. POTASSIUM CARBONATE: white crystalline powder, soluble in water, insoluble in alcohol. used for washing and cleansing purposes6. SODIUM CARBONATE: soluble in water but insoluble in alcohol7. CALCIUM HYDROXIDE- slaked lime.

Clinical features:Taste : bitter, pungent and soapy.Vomitus: strongly alkaline, at first thick and slimy. Later containing dark altered blood, sheds off mucous membranePurging: accompanied by severe pain and straining. Stools contain fibrous mucus mixed with blood.Inhalation of ammonia vapour: congestion of watering eyes, running nose and sneezing, salivation, suffocation.Causes of death: vagal inhibition, suffocation due to inflammation of glottis, Pul.edema, Pneumonia, perforation.Fatal dose: Ammonia: 30ml, Caustic soda: 5 gm, Pottasium carbonate: 15gm, Sodium carbonate: 30gm.Fatal period : 24 hrs.

POST-MORTEM APPEARANCES:Marks of corrosion : the mucous membranes of mouth, throat, pharynx etc. shows- soft mucilage like necrosed areas & inflamed patches of chocolate or black color.Stomach content : turbid, blood stained or coffee color.Perforation: esophagus/stomachStenosis may be found at the lower end of esophagus.MEDICO- LEGAL IMPORTANCE:Caustic soda- homicidal, criminal abortion.

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