14 CACHO, Patrice Dianne G.

PHARCHM 5 LEC
36 MORON, Rey Sebastian S. 4B-PH

CAUSTICS/CORROSIVE

I. BACKGROUND - ingestion causes more damage to the stomach than

CAUSTICS/CORROSIVES the esophagus
- a group of chemicals with the capacity to cause tissue - ingestion can cause a black bloody diarrhea, epigastric
injury on contact by a chemical reaction pain and esophageal strictures
- corrosives refer to acids while caustics are alkalis - commonly-used examples include hydrochloric acid,
- classified to two major categories: acids and alkalis sulphuric acid, and nitric acid

ACIDS ALKALIS
- strong acids with a pH ≤ 2 - strong bases with a pH ≥ 11.5
-  pH,  corrosive effect - esophagus is more severely affected than the stomach
- however, there are some substances like lemon juice - ingestion can cause thick and slimy vomit with blood
which are not corrosive despite the low pH - commonly-used examples include sodium hydroxide
- other factors include molarity, concentration, and and sodium hypochlorite
affinity for hydroxyl ions

AGENT DESCRIPTION USES FATAL DOSE

ACIDS
Hydrochloric acid colorless fuming liquid metal cleaner, drain 30 to 40 mL
(muriatic acid, spirit of yellow color upon exposure to air cleaner, laboratory reagent
salts) water solubility causes the irritating sensation in
the nose and the upper respiratory passages
higher ventilation may cause deeper
penetration in the mucosa of the respiratory
passages
Sulfuric acid heavy, oily, colorless, odourless, non-fuming electrolyte for storage 20 to 30 mL
(oil of vitriol, oleum, liquid batteries, used in 3.5 mL (some cases
battery acid) hygroscopic and reacts violently with water processing leather, fur, have report death of
giving off intense heat and food, laboratory ingestion as little as
formed through the photo oxidation of sulfur reagent this volume)
dioxide to sulfur trioxide and subsequent to
water, a component found in acid rain
Nitric acid colorless or yellow fuming liquid with an acrid used in glassblowing, 20 to 30 mL
(aqua fortis, azotic acid, odor engraving and
engraver’s acid) electroplating, farming,
welding, fire fighting and
industrial chemistry
ALKALI
Sodium hydroxide white crystalline, odorless solid drain cleaner, oven 10 to 15 g
(liquid sosa, caustic hygroscopic cleaner
soda)
Sodium hypochlorite greenish-yellow liquid household bleach 10 to 15 g
(bleach)

II. CHEMISTRY

Most acids are characterized by the presence of

hydrogen ions while most alkalis contain a hydroxide ion in
their structure.
Hydrochloric acid Sulfuric acid Nitric acid

Sodium hydroxide Sodium hypochlorite
III. MECHANISM OF TOXICITY
Acids
- cause tissue injury through coagulation necrosis
- hydrogen ions dessicate or denaturate epithelial
tissues producing an eschar (dry scab) which tends
to self-limit further damage which leads to edema,
erythema, mucosal sloughing, ulceration and
necrosis of tissuses
Alkalis
- cause tissue injury through liquefactive necrosis
- liquefaction necrosis occurs through protein
dissolution and fat saponification
- hydroxide ions (OH-) react with tissue collagen,
causing it to swell and shorten
- small vessel thrombosis and heat production
follows
- these mechanisms can lead to continuous
penetration into deeper tissues, resulting to
extensive damage
IV. CLINICAL TOXICOLOGY
Respiratory injury
- 100% oxygen
- Cricothyroidotomy
Ocular injury
- irrigation with NSS, LRS, or tapwater for 15 to 30
minutes or until pH 7.4 is achieved
- ophthalmic consultation
- antibiotics
Epidermal injury
- irrigation with NSS or tapwater for 15 to 30 minutes
- non-adherent gauze and wrapping
- topical antibiotics and steroid
- for deep second degree burns: topical silver
sulfadiazine
Abdominal injury
- make patient lie on his right side to prevent further
absorption
- give small amounts of water (120-240 mL for adults
and 120 mL for children)
- avoid neutralization as it may cause exothermic
reaction which can cause more harm to the patient
- induction of vomiting, stomach wash and use of
activated charcoal is contraindicated
- oral feeds depend on the degree of damage as
assessed by endoscopy
 Grade I (mild) - oral feeding on the first
day
 Grade II (moderate) - liquid ingestion
after 48 - 72 hours
 Grade III (severe) - jejunostomy tube
feedings after 48 - 72 hours
- emergency laparotomy is mandatory if there is
perforation or peritonitis
V. RELATED POISONS
Carbolic Acid/ - phenol
Carboxylic Acid
- disinfectant with aromatic odor or
“hospital odor”
- considered to be a mild corrosive
- toxic effects include CNS depression,
metabolic acidosis and renal damage
- treatment includes skin irrigation to
prevent absorption and activated
charcoal upon ingestion
Ammonia - highly water soluble gas
- due to its high water solubility,
ammonium hydroxide may form
which is an alkaline corrosive
- commonly used in agriculture,
mining, explosives and as cleaning
agent
- toxic manifestations include
cough, dyspnea, ocular irritations,
dermal burns and even necrosis of
the skin
VI. BIBLIOGRAPHY
- https://www.powellfab.com/technical_information/sodium_hypoch
lorite/what_is.aspx
- https://pubchem.ncbi.nlm.nih.gov/compound/sodium_hydroxide
- http://onlinelibrary.wiley.com/doi/10.1002/3527600418.mb76470
1e0024/pdf
- https://www.gov.uk/government/uploads/system/uploads/attachm
ent_data/file/337689/hpa_hydrogen_chloride_toxicological_overv
iew_v1.pdf
- http://onlinelibrary.wiley.com/doi/10.1002/3527600418.mb76649
3e0015/pdf
- https://www.ncbi.nlm.nih.gov/books/NBK201482/
- https://toxnet.nlm.nih.gov/cgi-
bin/sis/search/a?dbs+hsdb:@term+@DOCNO+748
- https://www.ncbi.nlm.nih.gov/books/NBK441921/
- http://onlinelibrary.wiley.com/doi/10.1002/3527600418.mb13107
3e0012/pdf