Hydrochloric acid

Background

• Strong acid, causes coagulation necrosis due to denaturation of proteins
• Most household bleaches are only 3-6% hydrochlorite solutions, but patients may have occupational exposures if working in steel picking, chemical manufacturing, oil/gas-well acidizing, and food processing
• HCl is combustion product of polyvinyl chloride (PVC), can cause chemical inhalation injury, can persist in air for up to an hour after fire extinguished

Clinical Features

• Can be systemically absorbed and → metabolic acidosis, hemolysis, AKI
• Dermal burns
• Ingestion
  • All patients with serious esophageal injuries have some initial sign/symptom
  • Dysphagia, odynophagia, epigastric pain, vomiting
  • Laryngotracheal injury: dysphonia, stridor, respiratory distress
    • Occurs via aspiration of caustic or vomitus or inhalation of acidic fumes
• inhalation injury
  • PVCs and other arrythmias
  • Delayed onset (2-12 hours) pulmonary edema
  • Dyspnea, chest pain
• Caustic keratoconjunctivitis
  • Severe eye pain, blepharospasm, reduced visual acuity
  • Altered ocular pH (normal = 7.0-7.2)
  • Conjunctival injection OR blanching, chemosis, hemorrhage, epithelial defects, corneal loss OR edema, perilimbal ischemia (white ring around iris)