Caustic and Corrosive (Abrasive) Substance Ingestion

The Accidental Caustic Ingestion

Caustic Ingestion, Corrosive (Abrasive) Substance Ingestion
When caustic and corrosive (abrasive) substances are drunk accidentally or for suicide, they can cause tissue damage through various chemical reactions along the passageways. Among the caustic substances, acidic (citrus [nitric acid], salt spirit [hydrochloric acid], descaling agent, mercury solutions, phenol, etc.) and alkali (bleach [sodium hydroxide]) substances come first. When these substances are taken orally, they can cause various degrees of damage to the areas they come into contact with, up to the mouth and intestines. 80% of the patients in caustic substance ingestion are in children younger than 5 years old. Since caustic substance ingestion in children is generally accidental and ingested in small amounts, the possibility of death and serious injury is lower than in adult patients.

Caustic Ingestion Symptoms

In the event of drinking caustic substance, the following symptoms may occur depending on the size of the injury:
  • Difficulty breathing
  • Dysphagia (difficulty swallowing)
  • Pain in the mouth and odynophagia (painful swallowing)
  • Chest pain
  • Abdominal pain
  • Nausea and vomiting
  • Hoarseness
  • Dysphonia or aphonia
  • Respiratory distress, tachypnea, hyperpnea
  • Cough

Physical examination findings can be deceiving, despite significant tissue damage. For example, although caustic material that passes through the mouth quickly causes serious damage to the esophagus, there may not be serious damage to the mouth. Conversely, even if there are severe lesions in the mouth, there may be no serious injury to the esophagus or any other area. Esophageal (esophagus) involvement may occur in the absence of oropharyngeal lesions.

In case of severe esophageal damage and perforation in the esophagus and the spread of caustic substance into the abdomen, the following symptoms may be added:
  • Drooling
  • Subcutaneous air
  • Peritonitis (Acute Abdominal, rebound sensitivity and decreased bowel sounds)
  • Hypotension
  • Shock
  • Hematemesis (bleeding from the mouth with vomiting)

Diagnostic Tests and Approaches in Caustic or Corrosive Substance Ingestion

In patients who drink caustic or corrosive substances, the respiratory tract should be checked first as in normal first aid rules and airway should be provided. After the emergency vascular access is established, fluid and medication support can be provided through the vascular access.

In addition to these, it is important to follow the heart and respiratory indicators.

Chest and abdominal radiographs may show some signs of damage (meidastinitis, abdominal air (pneumoperitoneum), extrapulmonary fluid (pleural effusion)). Apart from these, computed lung and abdominal tomography can provide more detailed information.

Emergency endoscopic examination is also required in the following situations:

In young children
- Older children and adults with symptoms indicating the damage listed above
Patients with abnormal mental status or mental disorders
- Those who deliberately ingested caustic or corrosive substances for suicide purposes
Endoscopy can be performed in patients who are thought to have swallowed concentrated or large amounts of substance.

However, esophageal endoscopy (esophagoscopy) should not be performed in patients with signs of perforation in the esophagus or gastrointestinal tract, severe airway edema or necrosis of the airways, and hemodynamically unstable patients, as this may increase the existing damage.

Despite the controversy, there are studies showing that endoscopic ultrasonography is very useful in evaluating the depth of lesions.

Treatment for Caustic or Corrosive Substance Ingestion

The product label of the drinkable substance (if available), the properties of the caustic or corrosive substance should be examined after the first approach interventions described above are performed on the patient who is brought due to drinking caustic or corrosive substances. In our country, the patient is attempted to be vomited incorrectly and it is aimed to remove the existing irritant material by mouth by touching the same ways again. These patients should never be vomited. Otherwise; the amount of existing burn will increase. According to the product that is swallowed or drunk, it should never be tried to be neutralized by swallowing another product (for example, if the patient consumes an acid-containing substance, drink a basic substance by mouth). In this case, thermal damage can be added in addition to chemical damage.

There are sources showing that it is appropriate to drink a small amount of water or milk. This has been shown to have no benefit after 30 minutes.

Interventions that provide control of the airways such as intubation, tracheotomy or cricothyrotomy may be required in patients with respiratory distress. By using large tubes, stomach contents can be evacuated by suction. Active charcoal ingestion by mouth is not recommended for caustic substance ingestion.

Small amounts of water can be given to patients who come to the stomach within the first 30 minutes after drinking caustic or corrosive substances in tubes sent to the stomach for dilution. In an emergency, the poison information center operating in our country (T.C. Ministry of Health - National Poison Information Center ­čô× : 114 ) can be consulted on the subject.

Administration of corticosteroids, broad spectrum antibiotics, and proton pump inhibitors that reduce gastric acid production are often recommended. In patients with extensive tissue damage, morphine may be required to control the current agitation and severity.

It is useful to ask patients for esophograms 3-4 weeks after the results of the damage.

Keeping these substances (especially cleaning products), which can have serious negative effects listed above, in an area where children cannot reach is the best precaution that can be done.

Resources:


Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

Private Office:
Address: ─░ncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bak─▒rk├Ây - ─░stanbul
Appointment Phone: +90 212 561 00 52
E-Mail: muratenoz@gmail.com 
Mobile phone: +90 533 6550199
Fax: +90 212 542 74 47



  
 


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