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Toxic Effect of Corrosive Alkalis

Corrosive Alkalis and Alkali like Substances


Presentation

  • When children present for reconstructive surgery, a gas induction is usually preferred.[academic.oup.com]
  • Care of respiration and coma if present. 2. Gastric lavage may be done in early presentation. 3. Symptomatic treatment and dialysis if renal failure occurs. 4. Skin lesions irrigated with water. 42.[slideshare.net]
  • Breathing: Potential aspiration of caustic gastric/oesophageal contents, thus acute lung injury Hypoxia may be present; supplemental oxygen may be required.[derangedphysiology.com]
  • So it's perhaps feasible to dispose of a body with \ce{HF} given a very large amount of time, but it's not possible in the timescale presented in the show.[chemistry.stackexchange.com]
  • Let's understand the risk it presents.[prevor.com]
Pain
  • Contact with the eyes may cause watering, pain, open sores and blindness. Ingesting corrosives can cause pain and inflammation of internal tissue as well as vomiting and diarrhea.[sciencing.com]
  • Either circumstance causes severe chest pain, fever, rapid heart rate, rapid breathing, very low blood pressure, and the need for surgery. Peritonitis results in severe abdominal pain when the stomach perforates.[merckmanuals.com]
  • Exposure to the respiratory system may range from mild irritation, to inflammation, chest pain, difficulty in breathing, pulmonary edema, and death. Mild exposure to the eyes may cause pain, tearing, and irritation.[www2.bakersfieldcollege.edu]
  • AIRWAYS AND LUNGS Breathing difficulty -- from breathing in fumes Throat swelling -- may also cause breathing difficulty EYES, EARS, NOSE, AND THROAT Severe pain in the throat Severe pain or burning in the nose, eyes, ears, lips, or tongue Vision loss[medlineplus.gov]
  • The child is symptomatic (e.g. throat pain, drooling, pain on attempting to swallow his own saliva, or has vomiting or abdominal pain). The child is kept NBM and admitted for observation and an endoscopy within 24 hours.[lifeinthefastlane.com]
Falling
  • If you've ever had the misfortune to get up close and personal with any of the strong acids, such as sulfuric acid or nitric acid, you know the chemical burn is much like having a hot coal fall onto your clothing or skin.[thoughtco.com]
  • She began a sabbatical at Harvard in the fall of '95. The work involved doing some model compound studies involving mercury chemistry with Steve Lippard's group at MIT.[corrosion-doctors.org]
  • If patient is convulsing, watch his breathing and protect him from falling and striking his head. Pull his chin forward so his tongue does not block his air passage. Do not give alcohol in any form.[psep.cce.cornell.edu]
  • Most household detergents fall into this category. Pepper spray is also an irritant. It can cause significant pain but usually does not affect vision and rarely causes any damage to the eye.[webmd.com]
Inflammation
  • […] re-epithelialization and reduce inflammation in corneal burns.[eyewiki.aao.org]
  • Ingesting corrosives can cause pain and inflammation of internal tissue as well as vomiting and diarrhea.[sciencing.com]
  • […] stage : in the first 10 days from ingestion; acute necrosis with mucosal blurring and dilated atonic esophagus subacute stage: 10-20 days after ingestion and characterized by esophageal ulceration chronic stage: occurs after 21 days with esophageal inflammation[radiopaedia.org]
  • Exposure to the respiratory system may range from mild irritation, to inflammation, chest pain, difficulty in breathing, pulmonary edema, and death. Mild exposure to the eyes may cause pain, tearing, and irritation.[www2.bakersfieldcollege.edu]
  • Topical steroids may be used to reduce inflammation and to facilitate healing early in the recovery period after a serious chemical injury.[webmd.com]
Gastric Lavage
  • Gastric lavage may cause the esophagus or stomach to perforate. If the trachea has been damaged, tracheostomy may be needed.[medical-dictionary.thefreedictionary.com]
  • Management Gastric lavage. Calcium should be given (Antidote) IV fluids to avoid precipitation of calcium oxalate in renal tubules. 51.[slideshare.net]
  • Important things NOT to do include: do not induce vomiting do not administer oral fluids do not administer activated charcoal do not attempt pH neutralisiation do not perform gastric lavage or insert an nasogastric tube (until endoscopy is performed)[lifeinthefastlane.com]
  • Gastric lavage and emesis are contraindicated because of the risks of further injury on re-exposure of the oesophagus.[inchem.org]
Physician
  • Updated by: Jesse Borke, MD, FACEP, FAAEM, Attending Physician at FDR Medical Services/Millard Fillmore Suburban Hospital, Buffalo, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M.[medlineplus.gov]
  • The American Journal of Gastroenterology, 87 (3), 337-41 PMID: 1539568 CLINICAL CASES Toxicology Conundrum About Dr Chris Nickson An oslerphile emergency physician and intensivist suffering from a bad case of knowledge dipsosis.[lifeinthefastlane.com]
  • It is strongly recommended that those with above average use of pesticides establish a regular health surveillance program with their physician.[psep.cce.cornell.edu]
  • However some physicians now recommend the use of flexible endoscopy to include the stomach and small intestine (panendoscopy) regardless of the presence of second or non-perforating third degree burns to the oesophagus.[inchem.org]
Dyspnea
  • Glottic and subglottic edema are rare and manifest as stridor and dyspnea. 4- Hypotension, tachycardia and changes in mental status signify shock. 5- Sepsis may develop shortly after presentation secondary to bacterial colonization of dead tissue. 6-[slideshare.net]
  • Answer and interpretation Complications include: Perforation Esophageal perforation and mediastinitis (chest pain, dyspnea, fever, subcutaneous edema) perforation of the stomach or small intestine resulting in peritonitis septic shock and multiple organ[lifeinthefastlane.com]
Vomiting
  • DO NOT INDUCE OR ENCOURAGE VOMITING FOR CORROSIVE POISONS![psep.cce.cornell.edu]
  • Coughing, drooling, an inability to swallow, vomiting, vomiting blood, and shortness of breath may occur.[merckmanuals.com]
  • In treating corrosive poisoning, vomiting must not be induced; gastric lavage must not be attempted; and no attempt should be made to neutralize the corrosive substance.[medical-dictionary.thefreedictionary.com]
  • First Aid - Do not induce vomiting. Dilute the acid immediately by drinking large quantities of water or milk. If vomiting persists, administer fluids repeatedly. Ingested acid must be diluted approximately 100 fold to render harmless to tissues.[water.usgs.gov]
Diarrhea
  • There may be hematemesis and diarrhea; the stools are watery, mucoid, bloody, and possibly stained with the poison or its products, resulting from its action on the contents of the alimentary tract.[medical-dictionary.thefreedictionary.com]
  • Ingesting corrosives can cause pain and inflammation of internal tissue as well as vomiting and diarrhea.[sciencing.com]
  • Ingestion of corrosive chemicals may cause immediate pain and burning in the mouth, throat, and stomach followed by vomiting and diarrhea. Perforation of the esophagus and stomach is possible.[www2.bakersfieldcollege.edu]
  • . • Abdomen – Alkali:Abdominal pain and Diarrhea ( blood stained mucoid) – Sulphuric acid: constipation “early" due to sever vomiting and nothing pass to intestine and late due to stricture. • Respiratory exposure: strider, dyspnea and pulmonary edema[slideshare.net]
Abdominal Pain
  • The child is symptomatic (e.g. throat pain, drooling, pain on attempting to swallow his own saliva, or has vomiting or abdominal pain). The child is kept NBM and admitted for observation and an endoscopy within 24 hours.[lifeinthefastlane.com]
  • pain Bloody stools Burns and possible holes of the esophagus (food pipe) Vomiting, possibly bloody HEART AND BLOOD Collapse Low blood pressure -- develops rapidly Severe change in blood acid level -- leads to organ damage SKIN Burns Holes in the skin[medlineplus.gov]
  • Peritonitis results in severe abdominal pain when the stomach perforates. Scarring of the esophagus results in narrowing (stricture), which causes difficulty in swallowing.[merckmanuals.com]
  • Acute complications: These include gastrointestinal haemorrhage and perforation of the gut (mediatinitis and peritonitis as suggested by increasing abdominal pain, persistent vomiting, direct and indirect tenderness and a rigid abdominal wall).[inchem.org]
Nausea
  • Esophageal injury and stricture may be a late complication.individual poisons in Symptoms This type of poisoning is marked by intense burning of the mouth, throat, pharynx, and abdomen; abdominal cramping, retching, nausea, and vomiting, and often collapse[medical-dictionary.thefreedictionary.com]
  • Dilution should be avoided if patients have nausea, drooling, stridor, or abdominal distention. Esophageal or gastric perforation is treated with antibiotics and surgery (see Acute Perforation of the GI Tract ).[msdmanuals.com]
Nausea
  • Esophageal injury and stricture may be a late complication.individual poisons in Symptoms This type of poisoning is marked by intense burning of the mouth, throat, pharynx, and abdomen; abdominal cramping, retching, nausea, and vomiting, and often collapse[medical-dictionary.thefreedictionary.com]
  • Dilution should be avoided if patients have nausea, drooling, stridor, or abdominal distention. Esophageal or gastric perforation is treated with antibiotics and surgery (see Acute Perforation of the GI Tract ).[msdmanuals.com]
Chest Pain
  • In severe cases involving strong caustic substances, a person may develop very low blood pressure (shock), difficulty breathing, or chest pain, possibly leading to death.[merckmanuals.com]
  • In mucous membranes and breathing passages they cause swelling, inflammation, chest pain and difficulty breathing. Contact with the eyes may cause watering, pain, open sores and blindness.[sciencing.com]
  • Esophageal perforation may result in mediastinitis, with severe chest pain, tachycardia, fever, tachypnea, and shock. Gastric perforation may result in peritonitis.[msdmanuals.com]
  • Exposure to the respiratory system may range from mild irritation, to inflammation, chest pain, difficulty in breathing, pulmonary edema, and death. Mild exposure to the eyes may cause pain, tearing, and irritation.[www2.bakersfieldcollege.edu]
  • Answer and interpretation Complications include: Perforation Esophageal perforation and mediastinitis (chest pain, dyspnea, fever, subcutaneous edema) perforation of the stomach or small intestine resulting in peritonitis septic shock and multiple organ[lifeinthefastlane.com]
Drooling
  • Symptoms and Signs Initial symptoms of caustic ingestion include drooling and dysphagia. In severe cases, pain, vomiting, and sometimes bleeding develop immediately in the mouth, throat, chest, or abdomen.[msdmanuals.com]
  • Coughing, drooling, an inability to swallow, vomiting, vomiting blood, and shortness of breath may occur.[merckmanuals.com]
  • His immediate distress alerted his nearby father who found him crying from mouth pain, drooling and unable to speak or swallow. The boy’s father immediately called an ambulance and tried to rinse his son’s mouth with water.[lifeinthefastlane.com]
  • Even if speech is preserved, there is a need for close liaison with a speech and language therapist as inability to swallow and drooling may occur. See multiple choice questions 24–26. References 1. Friedman EM.[academic.oup.com]
  • . • Mouth Drooling with swelling of tongue, difficulty of speech and dysphasia and corrosion. 17. • Abdomen – Alkali:Abdominal pain and Diarrhea ( blood stained mucoid) – Sulphuric acid: constipation “early" due to sever vomiting and nothing pass to intestine[slideshare.net]
Carpopedal Spasm
  • . - Muscle twitches in the face and extremities with carpopedal spasm. - Convulsions - Cardiac Arrhythmias - Kidney: dysuria, oxaluria, hematuria, oliguria 49. Chronic Exposure 1.[slideshare.net]
Ulcer
  • Collagenase inhibitors in prevention of ulcers of alkali-burned cornea. Arch. Ophthalmol. 83:352–353. Brown, S.I., Akiya, S., and Weller, C.A. 1969a.[nap.edu]
  • Grade III burns are deep ulcers and necrosis. These invariably progress to stricture formation.[derangedphysiology.com]
  • Findings in acute stage include mucosal edema, ulceration and sloughing of the mucosa with esophageal dilatation and atony.[radiopaedia.org]
  • Oesophageal and gastrointestinal burns Gastrointestinal signs and symptoms such as vomiting, haematemesis, increased salivation, ulcerative mucosal burns or dysphagia may occur.[academic.oup.com]
  • Dermal - Ulcerations of skin. Hydrochloric acid will probably not be absorbed through skin. First Aid - Remove contaminated clothing and shoes immediately.[water.usgs.gov]
Blurred Vision
  • Early signs and symptoms of a chemical eye burn are: Pain Redness Irritation Tearing Inability to keep the eye open Sensation of something in the eye Swelling of the eyelids Blurred vision Chemical Eye Burn Treatment Self-Care at Home For all chemical[webmd.com]
Blurred Vision
  • Early signs and symptoms of a chemical eye burn are: Pain Redness Irritation Tearing Inability to keep the eye open Sensation of something in the eye Swelling of the eyelids Blurred vision Chemical Eye Burn Treatment Self-Care at Home For all chemical[webmd.com]

Treatment

  • Index Description General Recommendation - 5 Severe Corrosion Treatment Recommended - 4 Severe Corrosion Treatment Recommended - 3 Moderate Corrosion Treatment Recommended - 2 Moderate Corrosion Treatment May Be Needed -1 Mild Corrosion Treatment May[water-research.net]
  • Treatment of white phosphorous and other chemical burn injuries at one burn center over a 51 year period. Burns. 2004;30(5):448–52.[link.springer.com]
  • Treatment Immediate treatment in a hospital is mandatory. It is important to try to discover the chemical substance ingested, and all materials such as food, bottles, jars, or containers should be saved.[medical-dictionary.thefreedictionary.com]
  • Treatment is supportive. Gastric emptying and activated charcoal are contraindicated. Perforation is treated surgically.[msdmanuals.com]

Prognosis

  • What Is the Prognosis for Chemical Eye Burns? Recovery depends on the type and extent of injury. Every exposure to foreign substances or “chemicals” does not necessarily result in injury. Chemical irritants seldom cause permanent damage.[emedicinehealth.com]
  • Endoscopy • Early endoscopy in symptomatic ingestions to define problem & prognosis. • Serial endoscopy is useful in following patient's clinical course. » From day 5 to 15 endoscopy should be avoided because during this period of maximal wound softening[slideshare.net]
  • 9.1.1 Ingestion 9.1.2 Inhalation 9.1.3 Skin exposure 9.1.4 Eye contact 9.1.5 Parenteral exposure 9.1.6 Other 9.2 Chronic poisoning 9.2.1 Ingestion 9.2.2 Inhalation 9.2.3 Skin exposure 9.2.4 Eye contact 9.2.5 Parenteral exposure 9.2.6 Other 9.3 Course, prognosis[inchem.org]
  • If clean water is available at the site of injury and a standard irrigating solution is not, then the eyes should immediately be washed out with water. [14] [15] Medical therapy Patients with mild to moderate injury (Grade I and II) have a good prognosis[eyewiki.aao.org]

Etiology

  • Alkali materials are found more commonly in building materials and cleaning agents and occur more frequently than acid injuries. [2] Etiology Chemical injuries occur as a result of acid, alkali, or neutral agents, with alkalis being responsible for 60%[eyewiki.aao.org]

Epidemiology

  • Epidemiology Chemical injuries to the eye represent between 11.5%-22.1% of ocular traumas. [1] About two thirds of these injuries occur in young men and children age 1-2 years are particularly at risk.[eyewiki.aao.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology 1. Local mild corrosive effect. 2.[slideshare.net]
  • Pathophysiological and aetiological considerations Alkali ingestion Alkaline substances are easier to swallow, as it hurts less than acid (they are a more common tool of suicide) Alkaline material mainly damages the oesophagus, as the stomach contains[derangedphysiology.com]
  • Chemical burns: pathophysiology and treatment. Burns. 2010;36:295–304. CrossRef PubMed Google Scholar 3. Sykes RA, Mani MM, Hiebert JM. Chemical burns: retrospective review. J Burn Care Rehabil. 1986;7:343–7. CrossRef PubMed Google Scholar 4.[link.springer.com]
  • Common causes of alkali and acid injuries are listed below. [2] [3] Pathophysiology Alkali Alkali agents are lipophilic and therefore penetrate tissues more rapidly than acids.[eyewiki.aao.org]
  • Pediatrics 71 (5):767-770 Haller JA, Andrews HG, White JJ, Tamer MA and Cleveland WW. (1971) Pathophysiology and management of acute corrosive burns of the esophagus: results of treatment in 285 children.[inchem.org]

Prevention

  • Intravenous fluids will be required if esophageal or gastric damage prevents ingestion of liquids.[medical-dictionary.thefreedictionary.com]
  • Collagenase inhibitors in prevention of ulcers of alkali-burned cornea. Arch. Ophthalmol. 83:352–353. Brown, S.I., Akiya, S., and Weller, C.A. 1969a.[nap.edu]
  • Carts used for moving chemicals should have a lip to prevent accidents. Reactions. Acids should always be added to water to prevent excessive heat generation and splashing. All corrosives should be mixed slowly.[www2.bakersfieldcollege.edu]
  • Transportation Hydrochloric acid should never be transported in other than a plastic coated glass container, accurately labeled, and properly stored within the vehicle to prevent shifting, spillage, or breakage.[water.usgs.gov]
  • The burning sensation of a solid particle sticking to a moist surface (such as the lips) may prevent a person from consuming much of the product.[merckmanuals.com]

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