Sulphuric Acid Poisoning

2 years ago 2079

Mode of Action of Corrosive Poison:

They act by extracting water from the tissues, and coagulate the cellular proteins, and convert hemoglobin into hematin.

 

Corrosives Poison Classification:

1) Strong acids:
Sulphuric, nitric, hydrochloric, Carbolic, oxalic, acetic, salicylic
2) Strong alkalis:
Hydrates and carbonates of sodium, potassium, and ammonia.
3) Metallic salts:
Zinc chloride, ferric chloride, copper sulphate, silver nitrate, potassium cyanide, chromates, and bichromates

 

Sulphuric Acid (Oil of vitriol; H2SO4) (Battery acid)

Properties

Pure sulphuric acid is a heavy, odorless, colorless, non-fuming, hygroscopic (tendency to absorb moisture), oily liquid, and has a tendency to carbonize organic substances.

Commercial H2SO4 is brown or dark in color.

It causes superficial burns after only one second of contact, and full-thickness burns after 30 seconds.

 

Fatal Dose: 5-10 ml

Fatal Period: 12-24 hours

 

Signs and Symptoms of H2SO4 Poisoning: (Ref Reddy)

The lips are usually swollen and excoriated, and brown or black streaks may be found extending from the angles of the mouth to the sides of the chin, and sometimes to the front of the neck due to the flow of the acid.
Teeth are chalky-white.
Tongue becomes swollen, sodden, and black.
There is corrosion of mucous membranes of the mouth, throat, and esophagus.
Burning pain in mouth, throat, stomach. Epigastric pain soon spreads all over the abdomen and thorax.
Thirst is intense, but any attempt to drink causes vomiting.
Eructation, nausea, and vomiting occur.
The vomit is brown or black, mucoid, strongly acid, and may contain shreds of the charred(brunt & blacken) wall of the stomach.
The abdomen becomes distended and very tender.
Constipation is severe, and there is tenesmus (feeling that you need to pass stools, even though your bowels are already empty).
Circulatory collapse may cause immediate death or may result from asphyxia due to edema of the glottis.
The voice becomes hoarse and husky.
The eyes are sunken and the pupils are usually dilated.
The mind remains clear till death.

If a person recovers, late oesophageal, gastric, and pyloric strictures and stenoses may develop. Permanent scars may also appear on the skin and oropharynx.

 

Cause of Death in H2SO4 Poisoning:

1) Circulatory collapse

2) Spasm or edema of glottis

3) Collapse due to perforation of the stomach.

4) Toxaemia

5) Delayed death may occur due to hypostatic pneumonia, secondary infection, renal failure, or starvation due to stricture of the esophagus.

 

Meaning

Hypostatic pneumonia: pneumonia resulting from infection developing in the dependent portions of the lungs due to decreased ventilation of those.

Stricture: Abnormal narrowing

Atelectasis: Collapse of Lung

Demulcent: Demulcents are substances that form a protective coating on the gastric mucosa membrane and thus do not permit the poisons to cause any damage.

Emetics: Medicine/Substances that cause vomiting.

 

Complications of H2SO4 Poisoning:

Acute Chronic
1) Upper airway obstruction and injury
2) G.l. hemorrhage
3) Oesophageal and gastric perforation
4) Sepsis
5) Tracheobronchial necrosis, atelectasis, and obstructive lung injury		 (1) Oesophageal obstruction
(2) Pyloric stenosis
(3) Vocal cord paralysis with airway obstruction.

 

Treatment of H2SO4 Poisoning: (Ref Reddy)

1) Avoid gastric lavage or emetics.

2) The acid should be immediately diluted and neutralized in situ by giving 1/4th liter of water or milk or milk of magnesia [Mg(OH)2] or lime water or soap suds or aluminum hydroxide gel, if the patient is seen within 30 minutes of ingestion.
Alkaline carbonates (CO3) and bicarbonates (HCO3), which liberate carbon dioxide should not be used, as they cause gastric distention and sometimes rupture.
3) Give a demulcent: olive oil, milk, egg-whites, starch water, mineral oil, melted butter.
4) Prednisolone (steroid) 60 mg./day may be given in divided doses to prevent oesophageal stricture and for shock. Later on 4 cm. diameter mercury-filled bougie should be passed daily if stricture develops.
5) Correct circulatory shock.
6) Tracheostomy, if there is edema of the glottis.
7) Give nothing by mouth. Nutrient substances are given by intravenous route for about a week. Then try liquids, soft food, and finally a regular diet.
8) Skin burns are washed with large amounts of water and a paste of magnesium oxide or sodium bicarbonate is applied.
9) Eye burns are irrigated with water or sodium bicarbonate solution for 10 to 15 minutes. A suspended i.v. the bag that administers low-pressure irrigation is ideal.
10) Symptomatic Treatment

 

 

Treatment of Mineral acid (Sulphuric, Nitric, HCl acid)

1. When skin including the eye is involved

  • Wash the affected parts with plenty of water and soap or sodium or potassium carbonate.
  • Later, a thick paste of magnesium oxide or carbonate is applied.
  • The eyes are washed with water and irrigated with a dilute sodium bicarbonate solution.
  • Later, a few drops of olive oil or castor oil are instilled into the eyes.

 

2. If acid is ingested

1. Avoid gastric lavage or emetics.
2. Drinking of plain water to dilute the acid
3. Use of weak solutions of non-carbonate alkalies eg. CaO, and MgO is recommended.
Alkaline carbonates (CO3) and bicarbonates (HCO3), which liberate carbon dioxide should not be used, as they cause gastric distention and sometimes rupture.
MgO - Magnesium oxide/magnesia
Mg(OH)2 - Milk of magnesia
4. Give a demulcent: olive oil, milk, egg-whites, starch water, mineral oil, melted butter.
5. Prednisolone (steroid) 60 mg./day may be given in divided doses to prevent oesophageal stricture and for shock.
Later on 4 cm. diameter mercury-filled bougie should be passed daily if stricture develops.
6. Correct circulatory shock.
7. Tracheostomy, if there is edema of the glottis.
8. Give nothing by mouth. Nutrient substances are given by intravenous route for about a week. Then try liquids, soft food, and finally a regular diet.
9. Symptomatic Treatment

 

Postmortem Appearances of H2SO4 Poisoning:

External

Corrosion of mucous membranes of lips, mouth, and throat, and of the skin over the chin, angles of the mouth, and hands is seen.

The necrotic areas are at first grayish-white, but soon become brown or black and leathery.

The clothing should be examined for bums and stains.

 

Internal:

Internal changes are limited to the upper digestive tract and the respiratory system.

The upper digestive tract is inflamed and swollen by edema and severe interstitial hemorrhage, even when corrosion is absent.

  • The greater part of the stomach may be converted into a soft, spongy, black mass that readily disintegrates when touched. Sometimes, only the pyloric region is involved, because the fluid pathway from the esophagus occurs usually along lesser curvature to the pylorus.
  • Perforation may occur with the escape of gastric contents into the peritoneal cavity, and if the patient lives for a few hours, chemical peritonitis and corrosion of organs is seen.
  • Perforation of the diaphragm may occur.

The duodenum may show similar but less intense changes, and the small intestine may show signs of irritation.

Corrosion or severe inflammation of the larynx and trachea may be present.

Secondary toxic swelling of the liver and kidney is seen if a person survives longer.

 

Circumstances of Poisoning:

1) Accidental poisoning results due to mistaking it fir glycerine or castor oil or from inhalation of vapor in chemical factories.

2) Most cases are suicidal.

3) It is not used for homicide, because of its acid taste, almost immediate local action, and the physical changes that it produces in the food.

4) It is taken internally or injected into the vagina as an abortifacient.

 

 

VITRIOLAGE (Vitriol throwing):

Throwing of sulphuric acid on another individual is known as vitriolage.

Jealous or disgruntled persons may throw a corrosive to disfigure and harm their enemies.

Sometimes, nitric acid, carbolic acid, corrosive alkali, or juice of marking nut or calotropis is used to disfigure the face.

 

Complication of Vitriolage

  1. Disfigured
  2. Repair is slow and the scar tissue causes contracture. (Scar Formation)
  3. Blindness may occur if the eyes are involved.
  4. They are penetrating burns and predispose to infection.
  5. Death

 

Cause of Death in Vitriolage

  • Shock
  • Toxaemia
  • Severe Burn

 

Treatment of Vitriolage:

  • Wash the affected parts with plenty of water and soap or sodium or potassium carbonate.
  • Later, a thick paste of magnesium oxide or carbonate is applied.
  • The eyes are washed with water and irrigated with a dilute sodium bicarbonate solution.
  • Later, a few drops of olive oil or castor oil are instilled into the eyes.

 

Punishment (Ref Selim Reza)

  • Death sentence
  • Life long prison