Carbolic acid (Phenol or C6H4OH)

Physical properties:
-

pure: short, colourless, prismatic, needle-like or needle-shaped

crystals/crystalline form
burning sweetish taste
crystals turn pink & liquefy on exposure to air
characteristic carbolic or phenolic or hospital smell or odour
fat soluble : hence can attack nervous system
freely soluble in glycerine, ether, alcohol, benzene
slightly soluble in water
commercial acid: dark-brown liquid with several impurities like cresol; used as
antiseptic & disinfectant; several derivatives: cresol , creosote (coal tar),
resorcinol, Lysol, dettol, thymol, menthol, tannic acid
cresol: is a methyl phenol with meta, ortho, para isomers; used as
disinfectant & antiseptic
creosote (coal tar): is a mixture of phenols & consists mainly of cresol &
guiacol; used as household remedy for coughs & found in many proprietary
preparations
resorcinol: is a colourless crystalline substance & is used for the t/t of skin
disease (ringworm, eczema, psoriasis)
Lysol: 50% soln of cresol (3-methyl phenol) in saponified vegetable oil;
disinfectant
dettol: is chlorinated phenol with turpineol = PCMX(Parachlorometaxylenol )
4.8% soln in isopropyl alcohol; non-toxic to adults practically; some fatalities
reported amongchildren; antiseptic
thymol: is alkyl derivative of phenol obtained from volatile oils of Thymus
vulgaris, Monarda punctata or Tachyspermum ammi; occurs in colourless
crystals with characteristic pungent odour & taste; used earlier as an
antihelminthic (for ankylostomiasis), antifungal & antiseptic
menthol
tannic acid
FD: 60 ml or 10-15 gm; FP: 3-4 hrs (rapid death in IU injection)
-Absorption: GIT by oral ingestion, RT by inhalation, intact skin by local
application or spillage, per rectum, vagina, serous cavities, wounds
-poisoning by carbolic acid is known as carbolism
Action:
locally corrosive
is a protoplasmic poison: coagulates protein but does not enter into chemical
combination; that enters in loose combination with proteins & penetrates
deep into tissue: necrosis & gangrene when applied on skin
nerve endings: first stimulated & then paralysed; resulting in anaesthesia
acts on cells of CNS(stimulates & then depresses it causing convulsions),
heart, kidney, liver

after absorption: widespread /extensive capillary damage & clotting in

superficial vessels

Excretion:
phenol is converted into hydroquinone & pyrocatechol in the body (kidneys)
before both being excreted in urine; these products turn urine olive green or
brown on standing & the phenomenon called carboluria; phenol =
nephrotoxic drug like heavy metals, methanol, oxalic acid, salicylates,
phenacetin, EDTA, penicillamine
a trace is excreted by lungs, salivary glands, skin & stomach
complete excretion or elimination: 36 hrs
partly detoxified by liver
Cause of death: syncope; asphyxia (resp failure/oedema of glottis)
complications: bronchopneumonia
signs & symptoms

Skin (local)

GIT
(local)
Burning
pain from
mouth to
stomach--tingling

RT (local)

CNS

Others

Pulmonary &
laryngeal
edema due to
irritation

Liver damage;
severe cases:
haemolysis,
methaemogobinae
mia

Burning/tingl
ing & then
numbness

Anaesthe
sia

Coagulative
necrosis
(painless
white
opaque
eschar,
black if deep
burns)
Eschar falls
off leaving
brown stain
in few days

painful &
difficult
deglutitio
n&
speech

Stertorous
breathing (slow
& labored
breathing
progressing to
cyanosis & resp
failure)
Aspiration
pneumonia
(vomiting):
causing
bronchitis,
bronchopneum
onia

Headache,
giddiness,
unconsciousness,
coma (phenol =
depressant of NS
esp the resp
centre)
Subnormal temp;
contracted
pupils; rapid,
feeble & irregular
pulse; face
covered with cold
sweat
Stertorous
breathing, dusky
cyanosis,
respiratory
alkalosis,
metabolic
acidosis

Damage to
nerve
endings

corroded
lips,
tongue,
mouth:
white &

Local effects
due to
inhalation of
phenolic
vapours

Convulsions,
lock-jaw

Scanty urine,
contains albumin,
free Hb,
suppression may
follow; carboluria
(greenish
coloration)
Oochronosis

Necrosis &
gangrene:
green-white
or brownwhite or
grey-white
sloughing

hardened
N/V: 20%
cases;
rare on
consumin
g dil.
soln. of
phenol;
rare
becoz of
anaesthe
sia
Local
effect
due to
oral
ingestion

Carbolic breath:
strong odour of
phenol in
breath

Lysol:
brownishpurple
discoloration
of tissues
Skin or
wound
contact
(local effect)
Oochronosis: deposition of oxidation products resulting in dark pigmentation
of cornea, cartilage, ligaments,etc seen in chronic phenol poisoning (phenol
maramus: wt loss, anorexia, headache vertigo, dark urine, skin, sclera );
associated with alkaptopnuria (an inborn error of metabolism with deposition
of homogentisic acid in cartilage, ligaments & fibrous tissue)

T/T:
depends upon route of administration
oral route:
gastric lavage or stomach wash with plenty of lukewarm water containing
activated charcoal, olive oil, castor oil, magnesium or sodium sulphate, or
saccharated lime, soap soln, 10% glycerine, etc combines with phenol

forming harmless products until washings are clear & odourless olive oil or
vegetable oil remove surface phenol & prevent deep penetration
30 mg MgSO4 or medicinal liquid paraffin after completion of lavage should
be left in stomach
demulcents (egg white) or Epsom salt orally
symptomatic: artificial respiration, tracheal aspiration of froth/secretions,
glucose saline to induce dieresis, saline containing 7g of NaHCO3 per litre is
given i.v. to combat circulatory depression, to dilute carbolic acid content of
blood, to encourage excretion by producing dieresis; haemodialysis if there is
renal failure; methylene blue i.v. if there is methaemoglobinaemia, etc
skin absorption:
remove contaminated clothings at once; cleanse the site by mopping with
wet cloth
wash skin with undiluted polyethylene glycol or soap & water for at least 15
mins
apply olive oil/methylated spirit/10% soln of ethyl alcohol act as solvents &
prevent further absorption
shift the victim to fresh atmosphere & make him breathe in fresh air
give normal saline + NaHCO3 (I/V drip)

PM appearances:
External:
grayish or brownish corrosion of skin in tracks from angles of mouth on to
chin, in front of body, arms & hands (splashes) with characteristic phenolic
odour about the mouth
white & swollen tongue
mucous membrane of lips, mouth & throat is corrugated, sodden, whitened or
ash-grey, partially detached, with numerous small submucous haemorrhages
Internal
corrosion of GI mucosa
laryngeal & pulmonary oedema
esophageal mucosa: tough, white or grey, corrugated, arranged in
longitudinal folds
stomach changes: reddish fluid mixed with mucus & shreds of epithelium
(vomitus & gastric lavage show partially detached gastric mucosa) with
phenolic odour on opening of stomach, hardened stomach giving leather
bottle appearance called as leathery stomach---mucous membrane thickened
& looks leathery, marked corrosion of gastric mucosa, mucosal folds are
swollen, covered by opaque, coagulated, grey or brown mucus membrane
(coagulated grayish or brownish silvery mucus on it), intervening mucosal

folds (furrows) appear dark-red, are less damaged, not opaque, partial
separation of necrotic mucosa with severe congestion of underlying tissue
duodenum & upper part of small intestine: similar but milder changes
kidneys: haemorrhagic nephritis when victim survives some time after
poisoning (delayed death)
liver & spleen: whitish, hardened patch where the stomach has been in
contact due to transudation of phenol
brain: congested, edematous
blood: dark, semifluid or partially coagulated
inhaled vomitus or poison: coagulation necrosis of mucosa, severe congestion
of submucosa of air-passagea, edema
preservative used for sending viscera for chemical examination:
supersaturated soln of NaCl
test: a few drops of 10% ferric chloride (FeCl2) soln to 1 ml of urine -----bluish
colour ; flase +ve: salicylates also give +ve results

ML importance:
used for suicidal purposes-----commonly used; rare (?)
accidental poisoning (at homes, accidental consumption or spillage)
rarely used for homicide because of its strong phenolic odour & taste
sometimes injected into uterus & vagina to produce abortion
its indiscriminate medical use (antiseptic & disinfectant; preservative for
vaccine & sera; occupational hazard) causes poisoning
oochronosis