https://wikem.org/w/index.php?action=history&feed=atom&title=Caustic_ingestion%2Fen 2026-04-18T23:25:19Z Revision history for this page on the wiki MediaWiki 1.38.2 https://wikem.org/w/index.php?title=Caustic_ingestion/en&diff=380589&oldid=prev 2026-01-07T12:42:46Z

<p>Updating to match new version of source page</p> <p><b>New page</b></p><div>&lt;languages/&gt;<br /> <br /> ==Background==<br /> <br /> [[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]<br /> [[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]]<br /> [[File:Illu esophagus.jpg|thumb|Esophagus anatomy and nomenclature based on two systems.]]<br /> {{Caustics background}}<br /> <br /> <br /> ==Clinical Features==<br /> <br /> *Signs and symptoms are inadequate to predict presence or severity of injury after caustic ingestion &lt;ref&gt;Gaudreault, P. et al. Predictability of esophageal injury from signs and symptoms: a study of caustic ingestion in 378 children. Pediatrics. 1983;71(5):767-770.&lt;/ref&gt;<br /> *Exam eyes and skin (splash and dribble injuries may easily be missed)<br /> *GI tract injury<br /> **[[Special:MyLanguage/Dysphagia|Dysphagia]], odynophagia, drooling, [[Special:MyLanguage/epigastric pain|epigastric pain]], [[Special:MyLanguage/vomiting|vomiting]]<br /> *Laryngotracheal injury<br /> **[[Special:MyLanguage/Dysphonia|Dysphonia]], [[Special:MyLanguage/stridor|stridor]], [[Special:MyLanguage/respiratory distress|respiratory distress]]<br /> **Occurs via aspiration of caustic or vomitus or inhalation of acidic fumes<br /> <br /> <br /> ==Differential Diagnosis==<br /> <br /> {{Caustic burn types}}<br /> <br /> <br /> ==Evaluation==<br /> <br /> <br /> ===Labs===<br /> <br /> Only necessary in patients with significant injury or volume of ingestion<br /> <br /> *CBC<br /> *Chemistry<br /> *Lactic Acid<br /> **In Alkali ingestion, presence of acidemia or hyperlactemia is likely indicative of clinically significant tissue injury&lt;ref&gt;Hoffman et al. Ingestion of Caustic Substances. N Engl J Med. 2020. Apr;382(18):1739-1748&lt;/ref&gt;<br /> *[[Special:MyLanguage/ECG|ECG]]<br /> *Calcium and Magnesium level (if [[Special:MyLanguage/hydrofluoric acid|hydrofluoric acid]] exposure)<br /> **Free Fluoride binds rapidly to calcium and magnesium leading to severe hypocalcemia and hypomagnesemia that can be life threatening<br /> *Acetaminophen and Salicylate levels (in patients with concern for intentional ingestion)<br /> <br /> <br /> ===Imaging===<br /> <br /> *3-View [[Special:MyLanguage/CXR|CXR]]<br /> **Look for free air under the diaphragm or signs of mediastinal air&lt;ref&gt;Muhletaler C. et al. Acid corrosive esophagitis: radiographic findings. AJR Am J Roentgenol. 1980. Jun;134(6):1137-40. PMID: 6770621&lt;/ref&gt;<br /> *Button battery XR - two rings, will likely need to remove it no matter where it is, whether post-pyloric or pre-pyloric<br /> *CT with contrast<br /> **Consider when perforated viscus is suspected but CXR is negative<br /> <br /> <br /> ==Management==<br /> <br /> *Prevent provider and continued patient exposure to the caustic agent by removing all clothing and decontaminating the patient<br /> *There is a possible benefit of water ingestion immediately after ingestion of a powdered caustic to irrigate adherent materials in oropharynx/esophagus if no airway concerns to prevent prolonged injury from the powder adhering to tissues&lt;ref&gt;Hoffman et al. Ingestion of Caustic Substances. N Engl J Med. 2020. Apr;382(18):1739-1748&lt;/ref&gt;<br /> <br /> <br /> ===Airway Management===<br /> <br /> *Monitor closely for [[Special:MyLanguage/stridor|stridor]], airway edema, hoarseness, or other signs of airway injury<br /> *[[Special:MyLanguage/Intubate|Intubate]] early if signs of airway injury exist, first sign of voice changes, inability to tolerate secretions or stridor before airway becomes more difficult to manage.<br /> *Consider awake fiberoptic or video laryngoscopy if concern for difficult airway<br /> *Blind nasotracheal intubation is contraindicated due to the potential for perforations and false passages<br /> <br /> <br /> ===Endoscopy===<br /> <br /> Should be performed in the first 24 to 48 hours after ingestion (too early can underestimate extent of injury, too late increases risk of wound softening and perforation).<br /> <br /> ;Indications:<br /> *Intentional ingestion (higher likelihood of high volume ingestion)<br /> *Unintentional ingestion with signs of:<br /> **[[Special:MyLanguage/Stridor|Stridor]]<br /> **Significant oropharyngeal [[Special:MyLanguage/burns|burns]]<br /> **[[Special:MyLanguage/Vomiting|Vomiting]]<br /> **Drooling<br /> **Food refusal<br /> <br /> <br /> ===Esophageal Stricture Mitigation&lt;ref&gt;High Doses of Methylprednisolone in the Management of Caustic Esophageal Burns. Pediatrics 2014;133:e1518–e1524&lt;/ref&gt;===<br /> <br /> *Discuss with GI or medical toxicologist<br /> *For grade IIb or higher esophageal burns:<br /> **[[Special:MyLanguage/Methylprednisolone|Methylprednisolone]] (1 g/1.73 m2 per day for 3 days)<br /> **[[Special:MyLanguage/Ranitidine|Ranitidine]]<br /> **[[Special:MyLanguage/Ceftriaxone|Ceftriaxone]]<br /> **Total parenteral nutrition<br /> *Sucralfate, Mitomycin C<br /> <br /> <br /> ===Surgical Intervention===<br /> <br /> *Indicated for:<br /> **Perforation<br /> **Peritoneal signs<br /> <br /> <br /> ===Caustic Specific Treatment===<br /> <br /> *Can include chelation, dialysis, or specific antidotes<br /> **Especially in caustics that cause systemic toxicity<br /> <br /> <br /> ===Controversial or Contraindicated===<br /> <br /> *[[Special:MyLanguage/Antibiotics|Antibiotics]]<br /> **No evidence to support or reject the use of prophylactic [[Special:MyLanguage/antibiotics|antibiotics]]<br /> **Only indicated if also giving [[Special:MyLanguage/steriods|steriods]] (see stricture mitigation above)<br /> *[[Special:MyLanguage/Activated charcoal|Activated charcoal]]<br /> **May infiltrate damaged mucosa &amp; interfere with EGD<br /> **Only consider when coingestants pose a risk for severe systemic toxicity<br /> **Zinc chloride and mercuric chloride systemic absorptions may outweigh interference with endoscopy<br /> *[[Special:MyLanguage/Gastric lavage|Gastric lavage]]<br /> **Contraindicated due to potential to cause reflux of caustic agent into esophagus, creating more damage<br /> **Blind nasogastric-tube insertion for irrigation can cause thermal injury through neutralization<br /> *Dilution with water or milk causes vomiting, elevating risk for perforation<br /> **Possible benefit only for solid alkali ingestions<br /> *Neutralization generates excess heat<br /> **Milk or magnesium citrate only for [[Special:MyLanguage/hydrofluoric acid|hydrofluoric acid]] ingestion<br /> <br /> <br /> ==Disposition==<br /> <br /> *All patients with symptoms from a caustic ingestion should be admitted for at least 24 hours of observation<br /> *All patients with intentional ingestion should be evaluated by psych prior to discharge<br /> [[File:Ingestion.png|thumb]]<br /> <br /> <br /> ===Prognosis===<br /> <br /> *Depending on severity may have full return of mobility and function or can progress to perforation followed by stricture formation <br /> *'''Days 2-14''' post-injury are associated with highest tissue friability / risk of perforation<br /> *Strictures typically develop in the first 2 months, higher risk in those with circumferential esophageal erosions (Grade 2B burns and above)<br /> *High-grade caustic burns associated with 1000x increase in esophageal adenocarcinoma or squamous-cell carcinoma<br /> <br /> <br /> ==See Also==<br /> <br /> *[[Special:MyLanguage/Caustic burns|Caustic burns]]<br /> <br /> <br /> ==References==<br /> <br /> &lt;references/&gt;<br /> <br /> [[Category:GI]]<br /> [[Category:Toxicology]]</div>

FuzzyBot