Caustic Ingestion is a topic covered in the 5-Minute Emergency Consult.

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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 stomach because of rapid transit time through esophagus:
      • Esophageal damage can occur (see “Alkalis”).
    • 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 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
  • Glass cleaners:
    • 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
      • Dishwasher preparations
      • Sodium hypochlorite
      • Bleaches
    • Sulfuric acid:
      • Car batteries
      • Button batteries

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Citation

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TY - ELEC T1 - Caustic Ingestion ID - 307121 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307121/all/Caustic_Ingestion ER -