Systemic toxicity due to other chemical properties of acids can occur following ingestion of acetic acid, arsenic and other heavy metal salts, cyanide, formic acid, hydrofluoric acid, hydrochloric acid, nitrates, sulfuric acid and phosphoric acid. An asymptomatic patient is unlikely to have severe injury although asymptomatic children may occasionally have a significant injury. Particular attention should be directed to securing the airway, fluid resuscitation and provision of opioid analgesia. Do not give activated charcoal as it will interfere with endoscopic evaluation. Ongoing supportive care includes maintenance of adequate analgesia, fluid, electrolyte and pH balance, nutritional support, and monitoring for the development of complications.
Parenteral nutrition is necessary in more severe cases.
Subsequent management and prognosis is largely dictated by findings at upper gastrointestinal tract endoscopy. Patients with endoscopic findings of oedema, erythema, superficial ulceration, blistering or erosions, may be fed orally. Corticosteroids are not indicated. Broad spectrum prophylactic antibiotics are not indicated unless there is evidence of gastrointestinal tract perforation or full thickness necrosis. Severely poisoned patients should be considered for admission to an Intensive Care Unit.