Crashing Patient

  • Home
  • EMCrit Blog
  • Index
  • Contact
You are here: Home / 14. Toxicology / Caustics

Caustics

July 14, 2011 by CrashMaster

Alakali

Liquidative esophageal necrosis, then strictures and motility dysfunction

Household bleach: hydrogen peroxide (3%), sodium hypochlorite, sodium hydroxide (1%) pH 10.8-11.4

Drain cleaners: sodium hydroxide (4%-54%)

Dishwasher Detergent: Sodium phosphate or tripolyphosphate

 

Lye=sodium or potassium hydroxide

 

Most commonly used household bleaches contain hydrogen peroxide (3%), sodium hypochlorite or low concentrations of sodium hydroxide (1%), and are mild to moderate irritants with a pH ranging from 10.8 to 11.4. 3 Accidental ingestion produces minimal injury to the gastrointestinal tract; long-term damage including stricture formation is rare. However, the ingestion of large quantities of bleach may be associated with serious damage.

 

(a) Substance. Household bleach ingestion in asymptomatic children does not warrant endoscopy. Similarly endoscopy may not be necessary in asymptomatic children who have ingested hair relaxer. (b) Quantity. Ingestion of larger quantities of corrosives is usually associated with greater damage. Although it is difficult to exactly quantify the amount, a cupful may be associated with significant injury while a teaspoonful may not. (c) Intention. Serious damage is noted when the intent is suicidal and endoscopy is usually indicated in such circumstances. (d) Symptoms. Persistent symptoms also warrant endoscopic examination.

scope within 12 hours (definitely within 24) Zargar SA, Kuchhar R, Mehta S, et al. The role of fibroptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc. 1991; 37:165–169.

Acid

Coagulative Dysfunction, so less damage to esophagus, but can get gastric

Toilet bowel cleaner: sulfuric and hydrochloric

antirust: oxalic hydrofluoric, hydrochloric,

battery fluid: sulfuric

swimming pool cleaner: hydrochloric

 

solutions with a pH < 2 or > 12 are most dangerous

 

 

Use large quantities of milk in the field

Batteries must be removed when swallowed

No NGT c alkali, ok in acid

Aspiration then Ice Water Lavage

 

One small RCT NEJM 1990 232:637-640 no benefit

then MA

Am J EM 1992 10:421-425

showed beneift of steroids and abx in grade II ulcerations

amp or clinda and

 

Solumedrol 20 Q8 if <2 y/o

Solumedrol 40 Q8 if >2 y/o

 

then prednisone 2 mg/kg po od x 2-3 weeks

Battery Ingestion Hotline:  202-625-3333

 

No SX and tolerating PO, observe for 6 hours then send home

Any Sx including stridor, drooling, dysphagia=endoscopy

 

Hydrogen Peroxide ingestion can lead to air embolism

 

 

 

|      |      |

Share this:

  • Print
  • Email

Filed Under: 14. Toxicology


Creative Commons License 2012. This site represents the opinions of Crashing Patient LLC. See here for full disclaimer.

© 2023 ·