Caustic ingestion
Ingestion of corrosive substances causing gastrointestinal and airway damage.
Caustic ingestion occurs when a corrosive substance is accidentally or deliberately taken into the body. The severity of damage to the oral mucosa, esophagus, and stomach lining depends on the substance's nature and exposure duration. Endoscopy of the upper digestive tract can assess injury, while CT scanning may help determine if surgery is needed.
Quick Facts
- Specialty
- Gastroenterology
- Emergency medicine
- Pulmonology
- Symptoms
- Pain
- drooling
- vomiting
- bleeding
- mouth and tongue swelling
- eye irritation
- Complications
- Esophageal stricture
- esophageal cancer
- aspiration pneumonia
- Onset
- Immediate
- Prevention
- Safe storage of caustic substances
- Treatment
- Surgery
- medications
- observation
Facts from the source article.
Signs and symptoms
Immediate effects include erosions of mucosal surfaces in the gastrointestinal tract or airway, which may bleed if a blood vessel is reached. Mouth and tongue swelling, drooling, hypersalivation, nausea, vomiting, dyspnea, dysphonia or aphonia, and eye or skin irritation occur. Perforation of the esophagus can cause mediastinitis; stomach or bowel perforation can lead to peritonitis. Airway swelling or laryngospasm may compromise breathing, with stridor and voice changes. Later complications include esophageal strictures or stenosis, causing chronic pain and malnutrition. Remote effects include esophageal cancer, most often appearing 10–30 years after ingestion.
Pathophysiology
Acids with a pH below 2 or alkalis with a pH above 12 cause the most extensive injuries. Alkalis saponify fats, producing liquefaction necrosis that allows deeper tissue penetration. Acids denature proteins via coagulation necrosis, which is thought to limit deeper spread. Injury severity is determined by pH, concentration, volume, contact duration, and percentage of body surface area involved.
Treatment
Common treatments for toxic ingestions are ineffective or harmful for caustic substances. Gastric emptying can worsen injuries; activated charcoal does not neutralize caustics and may obscure endoscopic views. Neutralization offers no clinical benefit, as it releases heat, causes gaseous distention, and induces vomiting. Airway compromise signs such as decreased consciousness, stridor, voice change, or inability to control secretions require intubation and mechanical ventilation. IV fluids maintain hydration. Endoscopy should occur within 24–48 hours, as later wound softening raises perforation risk. Endoscopically placed nasogastric tubes can stent the esophagus and allow feeding. CT with contrast may evaluate injuries. Surgical options include esophageal dilation, replacement, or stent implantation; when conservative treatment fails, reconstruction is performed.
Epidemiology
Most childhood ingestions involve small exploratory amounts, except in child abuse where larger quantities are ingested. Adult ingestions typically involve larger amounts during self-harm attempts, leading to more severe injuries. Common substances include ammonium hydroxide, sodium or potassium hydroxide, sodium hypochlorite, oxalic acid, and hydrochloric acid. Storage in water or drink containers increases accidental ingestion risk, especially in preschool-aged boys.
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