Caustic Ingestion

Basics

Description

  • Alkalis:
    • Dissociate in the presence of H2O to produce hydroxy (OH−) ions, which leads to liquefaction necrosis
    • Postingestion—mainly damages the esophagus:
      • Gastric damage can occur (see “Acids”)
    • Esophageal damage (in the order of increasing damage) consists of:
      • Superficial hyperemia
      • Mucosal edema
      • Superficial blisters
      • Exudative ulcerations
      • Full-thickness necrosis
      • Perforation
      • Fibrosis with resulting esophageal strictures
    • Do not directly produce systemic complications
  • Acids:
    • Dissociate in the presence of H2O to produce hydrogen (H+) ions, which leads to a coagulation necrosis with eschar formation
    • Postingestion—damages the esophagus (see “Alkalis”) and stomach because of rapid transit time through esophagus:
    • Gastric damage (in the order of increasing damage) consists of:
      • Edema
      • Inflammation
      • Immediate or delayed hemorrhage
      • Full-thickness necrosis
      • Perforation
      • Fibrosis with resulting gastric outlet obstruction
    • Well-absorbed and can cause hemolysis of RBCs and a systemic metabolic acidosis

Etiology

  • Direct chemical injuries
  • Injuries (dermal, ocular, respiratory, GI) occur secondary to acid and alkali exposures
  • Many caustic agents (acids and alkalis) are found in common household and industrial products
  • Caustic substances:
    • Ammonia hydroxide
    • Toilet bowel cleaner
    • Formaldehyde:
      • Embalming agent
    • Hydrochloric acid:
      • Toilet bowel cleaners
    • Hydrofluoric acid:
      • Glass etching industry
      • Microchip industry
      • Rust removers
    • Iodine:
      • Antiseptics
    • Phenol:
      • Antiseptics
    • Sodium hydroxide:
      • Drain cleaners
      • Drain openers
      • Oven cleaners
    • Sodium borates, carbonates, phosphates, and silicates:
      • Detergents (laundry powder, laundry pods)
      • Dishwasher preparations
      • Sodium hypochlorite
      • Bleaches
    • Sulfuric acid:
      • Car batteries
      • Button batteries

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