Acetic acid burn

An acetic acid burn is damage to skin tissue caused by exposure to this chemical and its fumes. Such burns can have serious consequences, so if they occur, immediate medical attention is required.

Causes acetic acid burns

The causes of acetic acid burns are often quite simple - carelessness in handling it. Many people have encountered such burns, since every person has used acetic acid at least once for household purposes.

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Pathogenesis

As a result of contact with the skin of aggressive substances (such as a concentrated acid solution or alkali), the process of rapid tissue necrosis begins. The effect of the acid continues until the chemical reaction ceases.

The effect of concentrated acids on the skin immediately causes the destruction and death of tissues and cells, so at the initial stage necrosis may be observed, which occurs almost immediately after contact with the skin.

After contact with the skin of solutions with a low concentration of acid, morphological changes may appear after some time (in some cases only after several days). The effect of acid on the skin causes the development of coagulation necrosis.

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Symptoms acetic acid burns

When burned by acid, a hard and dry crust appears at the site of damage, which has a clearly demarcated line where the healthy part of the skin begins. Damage from acid is often superficial. At the same time, acetic acid leaves dirty white burns on the skin.

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Acetic acid skin burn

Since vinegar is a member of the organic acid group, skin damage caused by this substance is called chemical burns. When it comes into contact with the skin, a chemical reaction begins, which causes damage.

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Acetic acid burn of the esophagus

Since the esophagus tissue contains many nerve endings, the burn victim feels severe pain that occurs behind the breastbone, in the neck area, and in the upper abdomen. In addition, burn marks and swelling can be seen in the mouth and on the lips. Due to the fact that the vocal cords are damaged by chemicals, hoarseness is observed. The tissues of the esophagus quickly swell due to the burn, as a result of which the lumen is blocked, which prevents the swallowing process.

Since there is also swelling in the larynx, shortness of breath occurs, which often causes vomiting, which is mixed with pieces of burnt mucous membrane of the digestive tract, blood and mucus. In some cases, spasmodic contractions of the esophagus are observed.

As a result of swallowing acetic acid, damage to the mucous membrane begins, and then to the rest of the digestive tract membranes. Chemicals have a destructive effect on cells, causing tissues to die. The areas of physiological narrowing of the esophagus are most severely damaged, as the acid is retained in them, causing even more severe burns.

In case of damage of the 3rd degree, a hole may appear in the wall of the digestive tract. In more severe cases, the bronchial wall is destroyed, which leads to the development of an esophageal-tracheal fistula.

General intoxication of the body also occurs, which develops as a result of the accumulation of toxins in it, which appeared as a result of tissue decay. Symptoms of poisoning are severe nausea and weakness, fever, and problems with the heart.

In general, the severity of damage to internal organs will depend on how much liquid the victim swallowed, as well as the acid concentration levels.

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Eye burn from acetic acid

The severity of damage to the eyeball will depend on what substance caused the burn (alkalis are more dangerous than acids). In the case of a burn with acetic acid, a protein coagulation reaction occurs, resulting in the formation of a crust. This prevents the acid from penetrating deep into the eye.

Also, the severity of destruction depends on the concentration indicator - if the victim will feel only a burning sensation from table vinegar, then the saturated vinegar essence immediately melts the cornea. As a result, vision is lost irreversibly, since 3 and 4 degrees of corneal opacity are almost incurable.

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Acetic acid vapor burn of the lungs

In some cases, intoxication with vinegar vapors occurs - in this case, coughing, watery eyes, and a runny nose are observed. General intoxication of the body occurs quite rarely. Chemical burns of the lungs can occur as a result of inhalation of saturated vapors of acetic acid. In this case, the victim will need immediate medical attention.

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Complications and consequences

Infectious complications that may arise as a result of an esophageal burn include gastritis and pneumonia, esophagitis, as well as peritonitis and pancreatitis in the reactive stage.

Other complications due to burns can be divided into 2 categories: early (on the 1st-2nd day) and late (from the 3rd day). The first group includes early bleeding (primary and secondary), mechanical asphyxia, acute reactive pancreatitis, intoxication delirium, primary oliguria. The second group includes pneumonia and tracheitis, as well as late bleeding and intoxication psychosis, cicatricial deformations inside the esophagus with possible subsequent cancerous degeneration of its walls, renal or hepatic failure.

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Diagnostics acetic acid burns

To establish a diagnosis of internal acetic acid burn, anamnesis data and clinical symptoms are assessed. Diagnosis of intoxication is based on the presence of vinegar odor from the mouth or gastric lavage.

In case of external burns, the type of damaging agent can be determined by the color and smell of the crust on the wound. In case of tissue contact with acetic acid, it becomes white, has a dense consistency, is dry, and is clearly limited within the damaged area.

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Tests

Laboratory tests may also be used to establish a diagnosis. The tests show an increase in acute inflammatory markers, in particular, C-reactive protein, an increase in ESR, and metabolic acidosis.

To determine the nature of the substance that caused the burn, samples of vomit, damaged tissue, and saliva can be sent for analysis within 2 days of the injury.

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Instrumental diagnostics

To determine the area of spread of burn destruction of the digestive tract in case of an internal burn, fluoroscopy is used. This method of instrumental diagnostics should be carried out only at the acute stage of the disease (no later than the first week after receiving the burn).

Differential diagnosis

Differential diagnostics of such poisoning is usually carried out without difficulties. In the process, the depth and prevalence of the lesion are determined, and all possible complications of the injury are promptly determined. Due to the presence of pronounced erythrocytolysis, poisoning with acetic essence is usually easily differentiated from burns from other cauterizing acids.

Treatment acetic acid burns

To avoid an exotoxic shock reaction, the victim is given fentanyl, analgin or promedol, and in addition, antispasmodic drugs such as papaverine or halidorin. To prevent pain, the patient should be given a solution of atropit or a glucose-novocaine mixture. These treatments will be very effective, but only if they are started no later than 6 hours after the injury.

Treatment of internal burns mainly consists of the use of anti-inflammatory drugs, as well as antibiotics. Often, the therapy process is based on the implementation of such a complex of therapeutic measures:

• Performing forced diuresis, which additionally alkalizes the blood;
• Use of sodium bicarbonate in case of development of metabolic acidosis;
• To eliminate burn shock, the drugs stabizol or refortan are used;
• Antibacterial agents may be prescribed to prevent the development of secondary infection;
• To reduce the risk of esophageal stenosis, hormonal drugs are used;
• In the development of DIC syndrome, transfusion of fresh frozen plasma is performed;
• If massive erythrocytolysis is observed, an early hemodialysis procedure should be performed;
• If the process of liver destruction has begun, glutaric acid is used.

If the burn of the digestive system is too severe, the patient is prescribed parenteral nutrition.

Almagel with added anesthesin can be used as a local therapy (taken every 3 hours). Sea buckthorn oil is used orally to speed up healing.

If cicatricial compression of the digestive tract has occurred, a bougienage procedure is performed. It is used to restore the patency and diameter of the esophagus. For this, special tubes are used, which are inserted into the victim's esophagus.

Bougienage is prescribed on an individual basis. There are several ways to perform the procedure - using a metal conductor or an esophagoscope, or blindly.

Before the operation, the patient is given drugs that reduce salivation, as well as painkillers. In accordance with the shape of the stenosis, a bougie of the appropriate size is selected, after which it is lubricated with Vaseline and inserted into the patient's esophagus, where it remains for 30 minutes. This procedure can cause internal bleeding and the development of inflammatory processes.

Help with acetic acid burns

Providing first aid for external acetic acid burns

If vinegar spills on clothing, the victim should first remove the item. If it cannot be removed, it should be cut and removed from the body in pieces.

After this, the burn site should be immediately placed under running water - this is one of the most important stages of the first aid procedure. The rinsing process should be abundant and long - at least 20 minutes. Another advantage of this procedure is that cold water reduces the pain from the burn. You can weaken the effect of vinegar with a soda solution or a simple soap solution.

If an aggressive substance gets on the mucous membrane of the eye, rinsing is performed in a similar manner. Running water can be alternated with a low-concentration soda solution, which must be thoroughly mixed.

After rinsing, you need to put a wet compress on the burnt area for a short time. It will remove any vinegar residue on the skin if it remains after rinsing.

The burn should also be treated with a disinfectant and a special anti-burn drug (Ricinol or Panthenol). After this, a bandage should be applied to the wound (it should be loose and not squeeze the affected area).

Providing quick help for an internal burn with vinegar

Internal burns are considered much more dangerous to health than external ones. They are fraught with serious consequences for the victim. If vinegar has penetrated the esophagus, then such a person needs to urgently wash the stomach with plain water with the addition of a soda solution. In this case, it is necessary to immediately call an ambulance team to provide professional assistance.

Medicines

Refortan is prescribed for the treatment of shock conditions resulting from infections, injuries or burns.

Contraindications to the use of the drug: high sensitivity to the components of the drug (e.g. starch), water intoxication, hypervolemia, potassium deficiency, excess sodium or chlorides, decompensated heart failure, renal failure with concomitant oliguria or anuria, intracranial hemorrhage, cardiogenic pulmonary edema, GD, severe problems with blood clotting, dehydration. It is prescribed with caution in case of renal, compensated cardiac (in chronic form) or hepatic failure, hemorrhagic diathesis, as well as intracranial hypertension.

Side effects include: the drug causes dilution of the infusion, which may reduce the hematocrit value, as well as the protein saturation index of the blood plasma (depending on the dosage). In addition, a transient decrease in the rate of blood clotting may be observed, but this does not affect the function of platelets, so it does not cause clinically significant bleeding.

Long-term daily use of Refortan in high and medium doses often causes skin itching, which is not easy to eliminate. In addition, it can occur several weeks after the end of treatment and persist for a long time.

Unless otherwise prescribed, Refortan is administered intravenously via a drip depending on the need to replace the VCP. The daily dosage, as well as the rate of intravenous administration, are selected depending on the hematocrit value, blood loss and hemoglobin concentration. For young patients, the hematocrit limit at which there will be no risk of developing pulmonary or cardiovascular complications is 30%.

The dosages of the drug are as follows: for adults and children 12+ years old, the average daily dose is 33 ml/kg; for children 3-6 and 6-12 years old, the average is 15-20 ml/kg; for children under 3 years old, the average is 10-15 ml/kg. For all ages, the maximum daily limit is 33 ml/kg.

Panthenol is used to speed up the healing process of the skin and mucous membranes in case of damage of various origins. The spray is used as follows - before applying to the skin, shake the can. Apply the medicine to the burn several times a day. The duration of therapy depends on the severity of the damage to the skin.

Among the side effects of the drug: in case of high sensitivity, an allergy may occur.

A contraindication to the use of Panthenol is high individual sensitivity to the components of the spray.

Folk remedies

There are folk methods of treating burns with acetic acid.

Summer oak bark: boil 1-2 tbsp of chopped bark for about 15-30 minutes (take 500 ml of water), then strain and leave to cool. Use the resulting medicine as compresses. It should be noted that only freshly prepared decoction can be used.

Hornbeam elm bark: pour boiling water (2 cups) over 2 tbsp of chopped bark, then keep on low heat until the volume of water is reduced by half, then strain. The decoction should be used for lotions, and the treatment procedure should be carried out daily 4-5 times.

Aspen bark: pour 1 tbsp of chopped bark with hot water (2 cups), then keep in a water bath in a closed container for 30 minutes. The hot decoction should be filtered through 2-3 layers of gauze, and then bring the volume of the medicine to the original indicator with boiled water. Use the decoction, pre-sweetened, 1-2 tbsp. 3-4 times a day during meals.

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Prevention

Prevention of chemical burns consists of carefully following safety rules when handling acid, as well as proper storage of aggressive substances.

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Forecast

An acetic acid burn can be extremely dangerous in severe cases (3rd degree burn) – in this case, mortality reaches 50-60%. In less dangerous cases, with proper and timely treatment of a burn of the digestive tract, the result is positive in 90% of situations.

In case of a 1st or 2nd degree eye burn, the prognosis is usually favorable. But with 3rd or 4th degree burns, the position of the edges of the eyelids often changes, a symblepharon or corneal leukoma occurs, which causes a sharp decline in vision.

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