Potential mechanisms of death in cases of fatal acid attacks

Abstract

Acid attacks refer to assaults where caustic substances such as an acid are thrown onto a victim. The usual purpose is to maim and disfigure and cause lifelong health and societal issues. Deaths uncommonly occur. Three cases are described involving females who were aged 14, 20 and 35 years respectively, who survived for some time after the attacks but later died. Postmortem findings confirmed that the deaths were due to septicemia and multiorgan failure. After an acid attack, death may be caused by a range of immediate, early and delayed complications. Hypovolemic shock may occur from loss of fluid exuding from the sites of deep burns. If the caustic agent has been inhaled or swallowed there may be mucosal, submucosal or deeper tissue injuries associated with mucosal edema and sloughing of pseudomembranes resulting in critical narrowing of the airways. Inhalation of fumes may also result in diffuse alveolar damage as a significant pathological finding. Further complications include acute renal failure, septicemia, acute respiratory distress syndrome and multiorgan failure. The prognosis of such injuries depends on the extent of the body surface that has been burned, the presence and extent of inhalation injuries, concomitant comorbid conditions and the age of the victim.