Emergency Medicine Book


Caustic Ingestion

Aka: Caustic Ingestion, Acid Ingestion, Base Ingestion, Alkali Ingestion, Poisoning by Alkalinizing Agent, Ingestion of Corrosive Chemical
  1. See Also
    1. Sodium Hypochlorite Poisoning (Chlorine Bleach Ingestion)
    2. Hydrogen Peroxide Poisoning
  2. Mechanism
    1. Significantly acidic (pH <5) or significantly basic (ph>9) ingestion
  3. Precautions
    1. Mouth lesions from ingestion do not correlate well with gastrointestinal lesions
    2. Intentional ingestion is associated with larger quantity ingestion (higher risk)
  4. Management
    1. ABC Management
      1. Be prepared to intubate for Stridor, Drooling, respiratory distress
    2. Have a low threshold to observe or admit patients even with only mild symptoms (esp. intentional ingestion)
      1. Consult poison control
    3. Significant chest or Abdominal Pain
      1. Consider CT Chest and CT Abdomen and Pelvis
      2. Consider gastroenterology or surgery for upper endoscopy within first 12-24 hours
        1. Endoscopy-related perforation risk increases after the first 24 hours
    4. Other measures
      1. Administer intravenous Proton Pump Inhibitor (e.g. IV Protonix) or H2 Blocker (e.g. IV Pepcid)
      2. Antibiotics are indicated for peritoneal signs
      3. Exercise caution with Nasogastric Tube placement
        1. Safest to place under direct visualization during endoscopy (to prevent perforation)
      4. Decision to use Corticosteroids is based on upper endoscopy findings (do not give empirically)
        1. Typically used in burns encompassing >75% of esophageal circumference (2B burn)
        2. Corticosteroids may prevent Esophageal Strictures
  5. References
    1. Claudius and Levine in Herbert (2019) EM:Rap 19(3): 4-5

acid ingestion (C0237965)

Concepts Injury or Poisoning (T037)
English acid ingestion
Derived from the NIH UMLS (Unified Medical Language System)

Poisoning by alkalinizing agent (C0274579)

Concepts Injury or Poisoning (T037)
SnomedCT 41221003
English alkalizing agent toxicity, alkalizing agent toxicity (diagnosis), toxicity from alkalizing agents, Poisoning by alkalinising agent, Poisoning by alkalinizing agent (disorder), Poisoning by alkalinizing agent, Poisoning by alkalinizing agent, NOS
Spanish intoxicación por agente alcalinizante (trastorno), intoxicación por agente alcalinizante
Derived from the NIH UMLS (Unified Medical Language System)

Ingestion of corrosive chemical (C2959520)

Concepts Injury or Poisoning (T037)
SnomedCT 445717001
English Ingestion of corrosive chemical (event), Ingestion of corrosive chemical
Spanish ingestión de sustancia química corrosiva, ingestión de sustancia química corrosiva (evento)
Derived from the NIH UMLS (Unified Medical Language System)

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