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4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katiha...

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POISIONING CENTER

Drug

Treatment Details

Nitric Acid (Aqua Fortis/Red Spirit of Nitre)

1} When pure, it is a clear, colowebsiteess, heavy liquid and has a peculiar and choking odour.
2} The brown colour of the commercial form is due to oxides of nitrogen {NO2 and NO3}

Route : Ingestion, Inhalation

Fatal dose : 10 to 15 ml

Fatal Period : 12 to 24 hours

Mechanism of action : An exothermic chemical reaction occurs when a mineral acid comes into contact with moist skin. The heat liberated together with the corrosion causes coagulation necrosis. This crust may prevent further penetration of the acid. It has no remote actions, all of its actions are local.

Clinical picture : 1} The lips, tongue, teeth, skin and clothes are white initially and later yellow due to ‘xantho-proteic reaction’.
2} There is eructation and abdominal distention because fuming is maximum with nitric acid {among acids}.
3} Inhalation of fumes causes lacrimation, photophobia, irritation of the air passages and lungs producing sneezing, coughing, dyspnoea and asphyxia.

Treatment : 1} Gastric lavage and emetics are contra-indicated.
2} The acid should be immediately neutralised or diluted in situ by giving one-fourth litre of water or milk or milk of magnesia or lime water or soap suds or aluminium hydroxide gel` if the patient is seen within 30 minutes of ingestion.
3} Alkaline carbonates and bicarbonates which liberate carbon dioxide are contra-indicated since they cause gastric distension and sometimes rupture.
4} Give a demulcent: olive oil, milk, egg-whites, starch water, mineral oil, melted butter.
5} Prednisolone 60 mg, day may be given in divided doses to prevent oesophageal stricture and counter shock.
6} Tracheostomy if there is glottic oedema.
7} Give nothing by mouth.
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 10-15 minutes. A suspended i.v. bag that administers low pressure irrigation is ideal.

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Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?

No, it should be used only after drug sensitivity report

Yes, under guidance of an infectious disease expert

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