Can Acid Ingestion Be Considered Corrosive Poisoning?
Yes, acid ingestion is definitively classified as corrosive poisoning and requires the same urgent management protocols as alkali ingestion. 1, 2
Definition and Classification
Acid ingestion falls under the broader category of corrosive poisoning, which encompasses both acidic and alkaline caustic substances. 3 The term "corrosive poisoning" is the appropriate medical terminology for any ingestion of substances that cause chemical burns and tissue destruction through direct contact with the gastrointestinal tract. 2
Common Corrosive Acids
- Sulfuric acid is the most frequently ingested corrosive acid, followed by hydrochloric acid 4
- Phosphoric and hydrofluoric acids cause specific systemic toxicity including hypocalcemia 1, 2
- All concentrated acids produce severe tissue damage requiring identical emergency management approaches 1
Injury Patterns in Acid Ingestion
Acids cause immediate coagulation necrosis of tissues, affecting primarily the esophagus and stomach, with the duodenum involved in severe cases. 4, 5 The physical form determines the damage pattern: liquids transit rapidly and induce burns throughout the upper gastrointestinal tract, while concomitant vapor aspiration may cause airway burns. 1
Severity Grading
All acid ingestions should be graded using the same classification system as other corrosive injuries:
- Grade I: Superficial mucosal injury 5
- Grade II: Deeper ulceration (IIa: partial thickness, IIb: circumferential deep ulcers) 5, 6
- Grade III: Full-thickness necrosis with risk of perforation 4, 5
Studies demonstrate that acid ingestions frequently result in Grade II or III injuries, with no mild (Grade I) injuries reported in some case series. 4
Systemic Effects Specific to Acids
Beyond local tissue damage, acid ingestion causes systemic toxicity that distinguishes it clinically but not categorically from other corrosives:
- Metabolic acidosis with low pH and elevated lactate levels 1, 2
- Hyponatremia and hypokalemia from strong acid exposure 1, 2
- Renal failure as a predictor of transmural necrosis 1
- Disseminated intravascular coagulation and multi-organ failure in severe cases 3
Management Approach
The management of acid ingestion follows identical protocols to other corrosive poisonings:
Immediate Actions
- Secure airway immediately if stridor, hoarseness, or respiratory distress present, as vapor inhalation causes severe airway burns 2
- Contact Poison Control Center (800-222-1222 in the United States) for agent-specific guidance 1, 2
- Never induce vomiting or perform gastric lavage, as these interventions are explicitly contraindicated and increase perforation risk 1, 2, 7
Diagnostic Evaluation
- Perform contrast-enhanced CT 3-6 hours after ingestion as the preferred initial diagnostic tool, which outperforms endoscopy in detecting transmural injuries 1, 2, 7
- Obtain urgent esophagogastroduodenoscopy within 12-24 hours to assess injury extent and grade severity 2, 8, 6
- Laboratory evaluation including CBC, electrolytes, renal function, liver enzymes, arterial blood gas, and lactate to assess systemic toxicity 1, 2
Surgical Indications
Emergency surgery is mandatory for perforation, extensive transmural necrosis, uncontrolled bleeding, mediastinitis, or peritonitis. 2, 7 The absence of post-contrast wall enhancement on CT indicates transmural necrosis and is an absolute indication for emergency surgical intervention. 1
Common Pitfalls
- Do not rely on oral lesions or clinical symptoms to predict gastrointestinal injury severity, as there is no reliable correlation 2, 7
- Do not administer water, milk, or activated charcoal unless specifically directed by poison control, due to risk of emesis and aspiration 1, 2
- Do not use antacids or neutralization agents, as they are contraindicated and may cause exothermic reactions with additional thermal injury 2
- Do not delay surgical consultation when transmural necrosis is suspected, as delayed intervention significantly increases mortality 7
Long-term Sequelae
Acid ingestion carries the same risk of complications as other corrosive poisonings: