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CAUSTICS Etiology:
- Ingestion of
lye (alkalin) and acids. Lye is found in "home" cleaning substances such as bleach, detergent, paint remover.
Acid is found in "industrial" cleaners, car batteries, metal plating solution
Lye ingestion causes liquefaction injury especially to the esophagus while acid causes coagulation injury especially to the stomach.
S & S:
- dysphagia, odynophagia, drooling, oral mucosa erythema/burn, stridor, difficulty breathing from laryngotracheal injury, sq emphysema (sign of pneumothorax or pneumomediastinum), dysphonia from edema to larynx,
pneumomediastinum from perforated esophagus accompanied by hemodynamic instability , GI bleed, strictures (delayed complication)
DX:
- CBC, SMA, Ca level (if hydrofluoric acid is ingested since
HF
binds Ca), CXR (to r/o esophageal/gastric perforation).
Treatment:
- ABC, IVF, NPO, pain meds, anti-emetics to decrease vomiting and the extent of lesions.
Do not try to neutralize acid with base and viceversa. This will aggravate the the lesions by causing thermal reaction.
Do Not Perform Decontamination
with the following: Emetics (re-exposes esophagus to caustic injury), Lavage/NGT (risk of perforation), Charcoal (not effective since it binds neither lye nor acids), Diluents (controversial, check with local Poison Control Center (PCC) for the latest).
Steroids (methylprednisolone 125 mg) maybe considered beneficial if given within 24 hrs. since they decrease inflammatory process and fibrosis (controversial, check with PCC for the latest).
Endoscopy should be performed by GI ASAP on a stable pt
to evaluate the length and depth of lesion. The estimation allows to predict the risk of perforation. If the lesions are deep, pt should go to unit for observation since deterioration can occur.
Consider also
ENT to evaluate edema of the airways and eventually
prophylactic intubation.
If lesion is limited and pt is not symptomatic, s/he can be discharged to psych for
evaluation or home if ingestion was accidental.
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