Caustic Ingestion

Basics

Caustics are substances that cause damage after contact with tissues
Classified based on pH: Alkalis or acids
Extent of injury dependent on various factors such as pH, volume, concentration, exposure time, and capability of chemical to penetrate tissues (also known as titratable acid or alkali reserve)
Patients that survive acute injuries may experience long-term complications such as fibrosis, strictures, and obstruction
Alkalis:
- Result in liquefactive necrosis injury pattern
- Hydroxide ions penetrate deep into tissues until neutralized resulting in damage to protein, fat, cell membranes, and transmural thrombus formation
- Primary organs damaged: Esophagus mainly but gastric damage can also occur
- Do not directly produce systemic complications
Acids:
- Result in coagulative necrosis injury pattern
- Hydrogen ions cause death of epithelial cells and eschar formation
- Also systemically absorbed resulting in hemolysis, end-organ injury, and metabolic acidosis
- Primary organs damaged: Esophagus and stomach because of rapid transit time through esophagus

Direct chemical injuries
Injuries (dermal, ocular, respiratory, GI) occur secondary to exposures
Many caustic agents (acids and alkalis) are found in common household and industrial products
Examples:
- 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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