Nitric acid poisoning: MedlinePlus Medical Encyclopedia

P Nitric acid is a poisonous clear-to-yellow liquid. This article discusses poisoning from swallowing or breathing in nitric acid.
P This article is for information only. DO NOT use it to treat or manage an actual poison exposure. If you or someone you are with has an exposure, call your local emergency number (such as 911), or your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.

T Poisonous Ingredient
P Nitric acid

T Where Found
- Fertilizers
- Substances used to clean metals (such as gun barrels)
P Note: This list may not be all inclusive.

T Symptoms
P Symptoms from swallowing nitric acid may include:
- Abdominal pain - severe
- Burns to skin or mouth
- Drooling
- Fever
- Mouth pain - severe
- Rapid drop in blood pressure (shock)
- Throat swelling, which leads to breathing difficulty
- Throat pain - severe
- Vomiting, bloody
P Symptoms from breathing in (inhaling) nitric acid may include:
- Bluish-colored lips and fingernails
- Chest tightness
- Choking
- Coughing
- Coughing up blood
- Dizziness
- Low blood pressure
- Rapid pulse
- Shortness of breath
- Weakness

T Home Care
P Seek medical help right away. DO NOT make a person throw up unless told to do so by Poison Control or a health care professional.
P If the chemical was swallowed, immediately give the person water or milk, unless instructed otherwise by a health care provider. Give 4 to 6 ounces (120 to 180 milliliters) of milk of magnesia, if possible.
P DO NOT give water or milk if the person is having symptoms (such as vomiting, convulsions, or a decreased level of alertness) that make it hard to swallow.
P If the person breathed in the poison, immediately move him or her to fresh air.

T Before Calling Emergency
P The following information is helpful for the emergency responders:
- The person's age, weight, and condition
- The name of the product (and ingredients and strengths, if known)
- The time it was swallowed or inhaled
- The amount swallowed or inhaled
P However, DO NOT delay calling for help if this information is not immediately available.

T Poison Control
P Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This hotline number will let you talk to experts in poisoning. They will give you further instructions.
P This is a free and confidential service. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

T What to Expect at the Emergency Room
P The health care provider will measure and monitor vital signs, including temperature, pulse, breathing rate, and blood pressure. The person may receive:
- Airway support, including oxygen, breathing tube through the mouth (intubation), and breathing machine (ventilator)
- Blood and urine tests
- Camera down the throat (endoscopy) to see burns in the food pipe (esophagus) and stomach
- Chest x-ray
- EKG (electrocardiogram, or heart tracing)
- Fluids through a vein (intravenous or IV)
- Medicines to treat symptoms
- Tube through the nose into the stomach to suction (aspirate) any remaining acid
P Hospital admission may be necessary to continue treatment. Surgery may be required if the esophagus, stomach, or intestines have developed holes (perforation) from exposure to the acid.

T Outlook (Prognosis)
P How well a person does depends on the amount of poison swallowed, how concentrated the poison is, and how quickly treatment was received. The faster a person gets medical help, the better the chance for recovery. Permanent injury and disability may occur.

T References
P Committee on Acute Exposure Guideline Levels; Committee on Toxicology; Board on Environmental Studies and Toxicology; Division on Earth and Life Studies; National Research Council. Nitric acid: acute exposure guideline levels. In: Committee on Acute Exposure Guideline Levels; Committee on Toxicology; Board on Environmental Studies and Toxicology; Division on Earth and Life Studies; National Research Council. Acute Exposure Guideline Levels for Selected Airborne Chemicals: Volume 14. Washington, DC: National Academies Press; 2013:appendix 5.
P Hoyte C. Caustics. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 148.
P National Library of Medicine; Specialized Information Services; Toxicology Data Network. Nitric Acid. Toxnet.nlm.nih.gov website. toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+hsdb:@term+@DOCNO+1665. Updated February 14, 2012. Accessed February 9, 2017.

T Review Date 1/31/2017
P Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Emeritus, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

