What are the common corrosive agents found in India?

Common Corrosive Agents in India

The most common corrosive agents found in India include sulfuric acid (often sold as toilet cleaners in water bottles), hydrochloric acid, and strong alkalis like lye, which are frequently involved in accidental and intentional poisonings due to inadequate regulation of their sale and storage.

Types of Common Corrosive Agents

Acids

• Sulfuric acid: Commonly found in toilet cleaners and battery acid

  • Often illegally sold in water bottles, leading to fatal accidental poisonings 1
  • Causes severe esophageal and gastrointestinal burns when ingested 2

• Hydrochloric acid: Found in household and industrial cleaning products

  • Together with sulfuric acid, accounts for a significant portion of chemical exposures 2

Alkalis

• Strong alkalis (lye): Most common corrosive agent involved in ingestions

  • Responsible for more than half of corrosive ingestion cases in some studies 3
  • Causes more severe esophagogastric burns compared to weak alkalis or non-alkali agents 3

• Weak alkalis: Less common but still present in household products

Epidemiology and Risk Factors

• Corrosive ingestion remains a common problem in India due to lack of strict regulations on the sale of caustic substances 4
• Both accidental and suicidal ingestions are documented:
  • Accidental ingestions often occur due to mistaken identity of containers 1
  • Suicidal attempts are more common in adolescents and adults 5
  • Children are more likely to experience accidental ingestions 5

Clinical Manifestations and Complications

Immediate Effects

• Severe esophageal and gastrointestinal burns
• Tissue necrosis and perforation
• Severe acidosis

Long-term Complications

• Gastrointestinal tract strictures (esophagus, stomach, pylorus, duodenum) 5
• Need for surgical interventions including total gastrectomy in severe cases 2
• Increased risk of esophageal carcinoma requiring long-term follow-up 6

Management Considerations

• Upper gastrointestinal endoscopy within 12-48 hours after corrosive ingestion is recommended to determine prognosis and management 6
• Contrast-enhanced CT scan 3-6 hours post-ingestion helps assess the extent of injury 6
• Endoscopic dilatation is the first-line treatment for resulting pyloric strictures 6
• Surgical intervention may be required for transmural necrosis 6

Prevention Measures

• Proper protective equipment when handling victims:

  • Appropriate protective clothing and gloves
  • Masks with non-return valve systems 6

• Regulatory recommendations:

  • Stricter laws regulating the sale of caustic substances
  • Prohibition of selling corrosive substances in beverage containers 1
  • Contact with Poison Control Centers for chemical-specific guidance 6

Pitfalls and Caveats

• Mistaking corrosive substances for drinking water is a significant risk when acids are sold in water bottles 1
• Delayed diagnosis of full-thickness esophagogastric necrosis can lead to prohibitive mortality 3
• Limited medical resources in developing countries can lead to worse outcomes 5
• Perforation risk is higher for caustic strictures compared to standard benign esophageal stricture dilatation (0.4-32%) 6

Understanding the common corrosive agents in India and their management is crucial for healthcare providers to effectively treat and prevent these potentially devastating injuries.