A young female has consumed carbolic acid accidentally. How will you establish the diagnosis and treat the patient? Describe the expected post-mortem findings in the event of death of such a patient.

Diagnosis

Establishing a diagnosis of carbolic acid poisoning requires a rapid and thorough assessment. Key steps include:

• History: Obtain a detailed history from the patient (if conscious) or bystanders regarding the substance ingested, the amount, and the time of ingestion. Look for characteristic odor on breath or clothing.
• Clinical Examination: Assess the patient’s airway, breathing, and circulation (ABC). Look for signs of oral burns, dysphagia, and abdominal pain. Neurological examination is crucial to assess for seizures or altered mental status.
• Laboratory Investigations:
  • Complete Blood Count (CBC): To assess for anemia or infection.
  • Electrolytes, BUN, Creatinine: To evaluate renal function.
  • Arterial Blood Gas (ABG): To assess acid-base balance and oxygenation.
  • Electrocardiogram (ECG): To monitor for cardiac arrhythmias.
  • Gastric Lavage: Considered if ingestion was recent (within 1 hour) and the patient is protected from aspiration. *Caution: Contraindicated if esophageal perforation is suspected.*
  • Endoscopy: Essential to assess the extent of esophageal and gastric burns.
• Toxicology Screen: While not always immediately available, a toxicology screen can confirm the presence of phenol.

Treatment

Treatment of carbolic acid poisoning is primarily supportive and aimed at minimizing absorption and mitigating systemic effects. The following steps are crucial:

• Decontamination:
  • Do NOT induce vomiting: Vomiting can cause further esophageal damage.
  • Gastric Lavage: As mentioned above, consider only if early and with airway protection.
  • Activated Charcoal: Generally *not* effective for phenol due to its corrosive nature and poor adsorption.
  • Dilution: Administer milk or water (15-30 ml/kg) to dilute the acid, *unless* there is evidence of esophageal perforation.
• Airway Management: Secure the airway with endotracheal intubation if there is evidence of airway compromise (e.g., stridor, hoarseness, respiratory distress).
• Cardiovascular Support: Monitor for hypotension and arrhythmias. Administer intravenous fluids and vasopressors as needed. Phenol can cause myocardial depression and arrhythmias.
• Renal Support: Monitor urine output and renal function. Consider hemodialysis if renal failure develops.
• Burn Management: Treat esophageal and gastric burns with appropriate supportive care, including pain management and nutritional support (parenteral nutrition may be required).
• Specific Antidotes: There is no specific antidote for phenol poisoning.

Post-Mortem Findings

In the event of death, the post-mortem examination will reveal characteristic findings:

• Oral Cavity: Burns and ulceration of the lips, tongue, and oral mucosa.
• Esophagus: Severe corrosive damage, often with perforation. The esophagus may be friable and easily ruptured.
• Stomach: Corrosive damage to the gastric mucosa, with ulceration and potential perforation. A characteristic odor of phenol may be present.
• Intestines: Damage may extend to the duodenum and small intestine, though typically less severe than in the esophagus and stomach.
• Kidneys: Acute tubular necrosis due to myoglobinuria (from muscle damage) and direct toxic effects.
• Heart: Myocardial damage and arrhythmias may be present.
• Lungs: Pulmonary edema may be present due to aspiration or systemic effects.
• Histopathology: Microscopic examination will reveal coagulative necrosis of the affected tissues.

The presence of a characteristic almond-like odor may also be noted during the autopsy, although this is not always present.