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; 37:165169.
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
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