Caustics and corrosives harm tissues through chemical reactions. Most are acidic or alkaline substances that damage tissue in water.
The chemical pH indicates its ability to accept or donate a proton to reflect its alkaline strength and chemical properties.
Substances with pH less than 2 are strong acids those with pH greater than 12 are bases.
Tissue injury severity from acidic or alkaline substances depends on contact duration, amount, and substance state. Chemical burns cause tissue necrosis, perforation, strictures, and cancer risks.
Coagulation necrosis forms denatured protein barrier limiting tissue penetration severe in acidic stomach.
Liquefactive necrosis penetrates tissues easily and damages the esophagus with prolonged exposure to substances.
Types of caustic agents are:
Acids
Alkaline
Epidemiology
Over 200,000 yearly exposures to cleaning substances with potentially harmful agents reported to US poison control centres.
Most caustic ingestions in under 5-year-olds. Rare serious solid ingestions due to children not swallowing burning particles.
Adult intentional ingestions have higher morbidity than in children due to larger volume and potential co-ingestants.
Work-related exposures worse than household due to higher concentration of industrial chemicals.
Adult ingestions intentional with higher volumes or concentrated substances to cause severe injuries.
Anatomy
Pathophysiology
Caustic chemicals damage tissues due to changes molecule structure and breaking bonds.
Acids are mostly harmful due to hydrogen ions (H+), while alkaline substances are harmful from hydroxide ions (OH-).
Alkaline ingestion leads to tissue damage through liquefactive necrosis and cell death from membrane disruption.
Acid ingestion occurs tissue damage through coagulation necrosis to cause desiccation or denaturation of proteins.
Pyloric and antral spasm can cause emesis causes gastric outlet obstruction from scar tissue contraction in 2 to 4 weeks.
Etiology
Causes of alkaline-containing sources are:
Ammonia containing products
Oven cleaning products
Drain-cleaning products
Swimming pool cleaning products
Automatic dishwasher detergent
Causes of acid-containing sources are:
Rust removal products
Metal cleaning products
Automotive battery liquid
Cement cleaning products
Drain cleaning products
Genetics
Prognostic Factors
The outlook depends on the strength and duration of exposure. Factors such as pH, volume, concentration, tissue penetration, and titratable reserve impact toxicity.
Reserve measures tissue neutralization for different substances. Deadly agents like hydrofluoric acid require small exposures, while household vinegar tolerates larger exposures.
Study of 839 adults treated for caustic ingestion injuries showed <50% 5-year survival rate for those with psychiatric diagnoses. Adults with psychiatric comorbidities shows poor prognosis.
Clinical History
Collect details including circumstances of ingestion, medical, and family history to understand clinical history of patient.
Physical Examination
Neurological Examination
Cardiovascular Examination
Gastrointestinal Examination
Respiratory Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Acute symptoms are:
Severe pain, drooling, stridor, vomiting, shock
Chronic symptoms are:
Dysphagia, malnutrition, strictures, fistulas, increased cancer risk
Differential Diagnoses
Dysphagia
Mercury Toxicity
Esophagitis
Gastroesophageal Reflux Disease
Hypocalcemia
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Airway monitoring and control is the top priority in caustic ingestion patients. A stable airway without perforation signs allows medical therapy.
Urgent EGD needed to assess injury severity and predict prognosis but may be unnecessary in asymptomatic patients for observation.
Pediatric patients with no symptoms for 2 to 4 hours post-ingestion can be discharged with follow-up and precautions.
Obtain material safety data sheets for workplace exposures from product container or labels.
Avoid causing vomiting or trying to neutralize the substance with weak acids or bases to prevent thermal chemical injuries.
Use diluent promptly post-alkaline ingestion to aid in particle removal from mouth and throat mucosa.
Initial medical interventions include airway management and decontamination along with endoscopic evaluation and esophageal balloon dilatation in severe cases.
use-of-phases-in-managing-caustic-ingestions
In the initial treatment phase, it includes evaluation of patient history, physical examination and laboratory test to confirm diagnosis.
Pharmacologic therapy is effective in the treatment phase as it includes use of antibiotics, proton pump inhibitor, and analgesic.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
Caustics and corrosives harm tissues through chemical reactions. Most are acidic or alkaline substances that damage tissue in water.
The chemical pH indicates its ability to accept or donate a proton to reflect its alkaline strength and chemical properties.
Substances with pH less than 2 are strong acids those with pH greater than 12 are bases.
Tissue injury severity from acidic or alkaline substances depends on contact duration, amount, and substance state. Chemical burns cause tissue necrosis, perforation, strictures, and cancer risks.
Coagulation necrosis forms denatured protein barrier limiting tissue penetration severe in acidic stomach.
Liquefactive necrosis penetrates tissues easily and damages the esophagus with prolonged exposure to substances.
Types of caustic agents are:
Acids
Alkaline
Over 200,000 yearly exposures to cleaning substances with potentially harmful agents reported to US poison control centres.
Most caustic ingestions in under 5-year-olds. Rare serious solid ingestions due to children not swallowing burning particles.
Adult intentional ingestions have higher morbidity than in children due to larger volume and potential co-ingestants.
Work-related exposures worse than household due to higher concentration of industrial chemicals.
Adult ingestions intentional with higher volumes or concentrated substances to cause severe injuries.
Caustic chemicals damage tissues due to changes molecule structure and breaking bonds.
Acids are mostly harmful due to hydrogen ions (H+), while alkaline substances are harmful from hydroxide ions (OH-).
Alkaline ingestion leads to tissue damage through liquefactive necrosis and cell death from membrane disruption.
Acid ingestion occurs tissue damage through coagulation necrosis to cause desiccation or denaturation of proteins.
Pyloric and antral spasm can cause emesis causes gastric outlet obstruction from scar tissue contraction in 2 to 4 weeks.
Causes of alkaline-containing sources are:
Ammonia containing products
Oven cleaning products
Drain-cleaning products
Swimming pool cleaning products
Automatic dishwasher detergent
Causes of acid-containing sources are:
Rust removal products
Metal cleaning products
Automotive battery liquid
Cement cleaning products
Drain cleaning products
The outlook depends on the strength and duration of exposure. Factors such as pH, volume, concentration, tissue penetration, and titratable reserve impact toxicity.
Reserve measures tissue neutralization for different substances. Deadly agents like hydrofluoric acid require small exposures, while household vinegar tolerates larger exposures.
Study of 839 adults treated for caustic ingestion injuries showed <50% 5-year survival rate for those with psychiatric diagnoses. Adults with psychiatric comorbidities shows poor prognosis.
Collect details including circumstances of ingestion, medical, and family history to understand clinical history of patient.
Neurological Examination
Cardiovascular Examination
Gastrointestinal Examination
Respiratory Examination
Acute symptoms are:
Severe pain, drooling, stridor, vomiting, shock
Chronic symptoms are:
Dysphagia, malnutrition, strictures, fistulas, increased cancer risk
Dysphagia
Mercury Toxicity
Esophagitis
Gastroesophageal Reflux Disease
Hypocalcemia
Airway monitoring and control is the top priority in caustic ingestion patients. A stable airway without perforation signs allows medical therapy.
Urgent EGD needed to assess injury severity and predict prognosis but may be unnecessary in asymptomatic patients for observation.
Pediatric patients with no symptoms for 2 to 4 hours post-ingestion can be discharged with follow-up and precautions.
Obtain material safety data sheets for workplace exposures from product container or labels.
Avoid causing vomiting or trying to neutralize the substance with weak acids or bases to prevent thermal chemical injuries.
Use diluent promptly post-alkaline ingestion to aid in particle removal from mouth and throat mucosa.
Emergency Medicine
Keep caustic agents out of children reach and use locked cabinets or storage areas.
Use hazard communication standards to ensure clear labelling.
Store hazardous substances in designated areas to prevent accidental ingestion.
Provide counselling and mental health care to individuals with a history of suicidal thoughts.
Proper awareness about caustic ingestions should be provided and its related causes with management strategies.
Appointments with a physician and preventing recurrence of disorder is an ongoing life-long effort.
Emergency Medicine
Ceftriaxone:
It inhibits cell-wall synthesis to bind penicillin-binding proteins.
Ampicillin/sulbactam:
It interferes with bacterial cell wall synthesis during active replication to cause bactericidal activity.
Emergency Medicine
Pantoprazole:
It binds to H+/K+ ATPase in gastric parietal cells with acid secretion.
Emergency Medicine
Morphine:
It inhibits ascending pain pathways to suppress cough in medulla.
Emergency Medicine
Initial medical interventions include airway management and decontamination along with endoscopic evaluation and esophageal balloon dilatation in severe cases.
Emergency Medicine
In the initial treatment phase, it includes evaluation of patient history, physical examination and laboratory test to confirm diagnosis.
Pharmacologic therapy is effective in the treatment phase as it includes use of antibiotics, proton pump inhibitor, and analgesic.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
Caustics and corrosives harm tissues through chemical reactions. Most are acidic or alkaline substances that damage tissue in water.
The chemical pH indicates its ability to accept or donate a proton to reflect its alkaline strength and chemical properties.
Substances with pH less than 2 are strong acids those with pH greater than 12 are bases.
Tissue injury severity from acidic or alkaline substances depends on contact duration, amount, and substance state. Chemical burns cause tissue necrosis, perforation, strictures, and cancer risks.
Coagulation necrosis forms denatured protein barrier limiting tissue penetration severe in acidic stomach.
Liquefactive necrosis penetrates tissues easily and damages the esophagus with prolonged exposure to substances.
Types of caustic agents are:
Acids
Alkaline
Over 200,000 yearly exposures to cleaning substances with potentially harmful agents reported to US poison control centres.
Most caustic ingestions in under 5-year-olds. Rare serious solid ingestions due to children not swallowing burning particles.
Adult intentional ingestions have higher morbidity than in children due to larger volume and potential co-ingestants.
Work-related exposures worse than household due to higher concentration of industrial chemicals.
Adult ingestions intentional with higher volumes or concentrated substances to cause severe injuries.
Caustic chemicals damage tissues due to changes molecule structure and breaking bonds.
Acids are mostly harmful due to hydrogen ions (H+), while alkaline substances are harmful from hydroxide ions (OH-).
Alkaline ingestion leads to tissue damage through liquefactive necrosis and cell death from membrane disruption.
Acid ingestion occurs tissue damage through coagulation necrosis to cause desiccation or denaturation of proteins.
Pyloric and antral spasm can cause emesis causes gastric outlet obstruction from scar tissue contraction in 2 to 4 weeks.
Causes of alkaline-containing sources are:
Ammonia containing products
Oven cleaning products
Drain-cleaning products
Swimming pool cleaning products
Automatic dishwasher detergent
Causes of acid-containing sources are:
Rust removal products
Metal cleaning products
Automotive battery liquid
Cement cleaning products
Drain cleaning products
The outlook depends on the strength and duration of exposure. Factors such as pH, volume, concentration, tissue penetration, and titratable reserve impact toxicity.
Reserve measures tissue neutralization for different substances. Deadly agents like hydrofluoric acid require small exposures, while household vinegar tolerates larger exposures.
Study of 839 adults treated for caustic ingestion injuries showed <50% 5-year survival rate for those with psychiatric diagnoses. Adults with psychiatric comorbidities shows poor prognosis.
Collect details including circumstances of ingestion, medical, and family history to understand clinical history of patient.
Neurological Examination
Cardiovascular Examination
Gastrointestinal Examination
Respiratory Examination
Acute symptoms are:
Severe pain, drooling, stridor, vomiting, shock
Chronic symptoms are:
Dysphagia, malnutrition, strictures, fistulas, increased cancer risk
Dysphagia
Mercury Toxicity
Esophagitis
Gastroesophageal Reflux Disease
Hypocalcemia
Airway monitoring and control is the top priority in caustic ingestion patients. A stable airway without perforation signs allows medical therapy.
Urgent EGD needed to assess injury severity and predict prognosis but may be unnecessary in asymptomatic patients for observation.
Pediatric patients with no symptoms for 2 to 4 hours post-ingestion can be discharged with follow-up and precautions.
Obtain material safety data sheets for workplace exposures from product container or labels.
Avoid causing vomiting or trying to neutralize the substance with weak acids or bases to prevent thermal chemical injuries.
Use diluent promptly post-alkaline ingestion to aid in particle removal from mouth and throat mucosa.
Emergency Medicine
Keep caustic agents out of children reach and use locked cabinets or storage areas.
Use hazard communication standards to ensure clear labelling.
Store hazardous substances in designated areas to prevent accidental ingestion.
Provide counselling and mental health care to individuals with a history of suicidal thoughts.
Proper awareness about caustic ingestions should be provided and its related causes with management strategies.
Appointments with a physician and preventing recurrence of disorder is an ongoing life-long effort.
Emergency Medicine
Ceftriaxone:
It inhibits cell-wall synthesis to bind penicillin-binding proteins.
Ampicillin/sulbactam:
It interferes with bacterial cell wall synthesis during active replication to cause bactericidal activity.
Emergency Medicine
Pantoprazole:
It binds to H+/K+ ATPase in gastric parietal cells with acid secretion.
Emergency Medicine
Morphine:
It inhibits ascending pain pathways to suppress cough in medulla.
Emergency Medicine
Initial medical interventions include airway management and decontamination along with endoscopic evaluation and esophageal balloon dilatation in severe cases.
Emergency Medicine
In the initial treatment phase, it includes evaluation of patient history, physical examination and laboratory test to confirm diagnosis.
Pharmacologic therapy is effective in the treatment phase as it includes use of antibiotics, proton pump inhibitor, and analgesic.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
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