Caustic Ingestion (Cleaning Products)

Caustic agents are acidic or alkaline substances that damage tissues severely if ingested. Alkali ingestion typically damages the esophagus Esophagus The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part. Esophagus via liquefactive necrosis, whereas acids cause more severe gastric injury leading to coagulative necrosis. Ingestion of large volumes and high concentrations of caustic agents can lead to severe and extensive injuries. Additionally, aspiration affects the laryngeal and tracheobronchial structures. Signs and symptoms include oral pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain, burns Burns A burn is a type of injury to the skin and deeper tissues caused by exposure to heat, electricity, chemicals, friction, or radiation. Burns are classified according to their depth as superficial (1st-degree), partial-thickness (2nd-degree), full-thickness (3rd-degree), and 4th-degree burns. Burns, dysphagia Dysphagia Dysphagia is the subjective sensation of difficulty swallowing. Symptoms can range from a complete inability to swallow, to the sensation of solids or liquids becoming "stuck." Dysphagia is classified as either oropharyngeal or esophageal, with esophageal dysphagia having 2 sub-types: functional and mechanical. Dysphagia, vomiting, and abdominal pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain. Severe injuries can present with shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock, abdominal rigidity, respiratory distress, and/or altered mental status. Diagnosis is based on laboratory tests, abdominal and chest imaging, and endoscopy within 24 hours (if without contraindications) to determine the extent of damage. Management involves stabilizing the cardiorespiratory status, decontamination, and supportive therapy. Severe injury may require surgery.

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Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

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Overview

Introduction

Caustics and corrosives cause tissue injury by a chemical reaction.

Injury by alkaline chemicals is overall more toxic than that caused by acidic substances:

  • Alkaline substances:
    • Most common
    •  Include sodium or potassium hydroxide (“lye”) present in drain cleaners, household cleaning products, and disc batteries
  • Acidic substances include concentrated hydrochloric, sulfuric, and phosphoric acids present in toilet-bowl cleaners and battery fluids.

Caustic ingestion:

  • Usually accidental in children
  • Usually intentional in adults
  • Associated with psychiatric illnesses

Epidemiology

  • In the United States, cleaning substances account for > 190,000 exposures annually.
  • 80% of ingestion of caustic substances noted in children < 5 years of age
  • Occupational exposures are often more severe because industrial products are more concentrated than household products.

Etiology

Common acid-containing products:

  • Toilet-bowl cleaners
  • Rust-removal products
  • Metal-cleaning products
  • Cement-cleaning products
  • Drain cleaners
  • Automotive battery liquid

Common alkali-containing products:

  • Drain cleaners
  • Ammonia-containing cleaning supplies
  • Swimming-pool cleaners
  • Oven cleaners
  • Automatic dishwasher detergents
  • Hair relaxers
  • Bleach
  • Cement

Pathophysiology

Tissue injury occurs by changing the ionized state and structure of molecules, thereby disrupting the covalent bonds.

Alkaline ingestion

  • The hydroxide ion (OH-) in alkaline substances is responsible for toxicity.
  • Accepts a proton in aqueous solutions and causes a chemical reaction → liquefactive necrosis:
    • Saponification of fats 
    • Solubilization of proteins
    • Disruption of cellular membranes and emulsification →  cell death Cell death Injurious stimuli trigger the process of cellular adaptation, whereby cells respond to withstand the harmful changes in their environment. Overwhelmed adaptive mechanisms lead to cell injury. Mild stimuli produce reversible injury. If the stimulus is severe or persistent, injury becomes irreversible. Apoptosis is programmed cell death, a mechanism with both physiologic and pathologic effects. Cell Injury and Death 
  • Effects:
    • Full-thickness burn/penetrating injury:
      • Occurs within seconds of ingestion and lasts 3–4 days
      • Leads to perforation and mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis in severe cases
    • Vascular thrombosis and mucosal inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation → focal or extensive sloughing and ulceration
    • Progressive thinning of esophagus Esophagus The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part. Esophagus from sloughing, and development of fibrosis over 2 weeks
    • Process of re-epithelialization can take up to 3 months.
  • Partial neutralization of the ingested alkali by gastric acidity results in generally decreased stomach Stomach The stomach is a muscular sac in the upper left portion of the abdomen that plays a critical role in digestion. The stomach develops from the foregut and connects the esophagus with the duodenum. Structurally, the stomach is C-shaped and forms a greater and lesser curvature and is divided grossly into regions: the cardia, fundus, body, and pylorus. Stomach injuries.
  • Specific injury with disk batteries (button batteries):
    • Can adhere to the esophageal or gastric mucosa
    • Adherence leads to perforation due to prolonged contact with extruded chemicals (sodium hydroxide or potassium hydroxide) and residual electrical discharge.

Acid ingestion

  • Hydrogen ions (H+) of acid are responsible for principal toxic effects
  • Acids can donate a proton in an aqueous solution causing a chemical reaction → coagulation necrosis:
    • Desiccation or denaturation of superficial tissue proteins
    • Thromboses of mucosal microvasculature
  • Effects:
    • Formation of an eschar or coagulum (which is protective, lessening the damage of deeper tissues)
    • In < 5 days, the eschar sloughs off and granulation tissue fills in, rendering the area susceptible to perforation
    • Obstruction can occur as the scar contracts.
  • Causes pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain upon contact in the oropharynx: limits the amount of acidic substances ingested
  • Significant exposure may result in the GI absorption of acidic substances, which can affect other systems:
    • Metabolic acidosis Metabolic acidosis The renal system is responsible for eliminating the daily load of non-volatile acids, which is approximately 70 millimoles per day. Metabolic acidosis occurs when there is an increase in the levels of new non-volatile acids (e.g., lactic acid), renal loss of HCO3-, or ingestion of toxic alcohols. Metabolic Acidosis
    • Hemolysis
    • AKI AKI Acute kidney injury refers to sudden and often reversible loss of renal function, which develops over days or weeks. Azotemia refers to elevated levels of nitrogen-containing substances in the blood that accompany AKI, which include BUN and creatinine. Acute Kidney Injury

Notable factors affecting injury

  • pH:
    • > 12: considered a strong base
    • < 2: considered a strong acid
  • Substance consistency:
    • Alkaline: viscous (longer contact time)
    • Acid: flows/passes down more quickly
  • Duration of contact: ↑ time, ↑ damage
  • Commonly affected anatomy:
    • Alkaline ingestion: esophagus Esophagus The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part. Esophagus is commonly damaged
    • Acidic ingestion:
      • Upper airway ( pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain on contact, causing gagging and choking, which damage the upper airway) 
      • Stomach 
  • Volume and concentration of the ingested solution: Large volumes and higher concentrations result in more extensive damage.
  • Physical form:
    • Solid: localized effect/injury, as these can adhere to the mucosa and not reach the stomach Stomach The stomach is a muscular sac in the upper left portion of the abdomen that plays a critical role in digestion. The stomach develops from the foregut and connects the esophagus with the duodenum. Structurally, the stomach is C-shaped and forms a greater and lesser curvature and is divided grossly into regions: the cardia, fundus, body, and pylorus. Stomach
    • Liquid: affect larger surfaces/areas

Mnemonic

To help recall the damage caused by alkalis and acids, the following mnemonic may be used:

Alkaline = liquefactive necrosis 

Acidic = coagulation necrosis

Related videos

Clinical Presentation

  • Oropharyngeal injury:
    • Oral pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain
    • Hypersalivation
    • Whitening of the tongue Tongue The tongue, on the other hand, is a complex muscular structure that permits tasting and facilitates the process of mastication and communication. The blood supply of the tongue originates from the external carotid artery, and the innervation is through cranial nerves. Oral Cavity: Lips and Tongue 
    • Oropharyngeal burns Burns A burn is a type of injury to the skin and deeper tissues caused by exposure to heat, electricity, chemicals, friction, or radiation. Burns are classified according to their depth as superficial (1st-degree), partial-thickness (2nd-degree), full-thickness (3rd-degree), and 4th-degree burns. Burns and ulcerations
  • Laryngeal damage:
    • Hoarseness
    • Stridor
  • Esophageal damage:
    • Dysphagia
    • Odynophagia
  • Gastric damage: 
    • Epigastric pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain
    • Hematemesis
    • Retrosternal or back pain Back pain Back pain is a common complaint among the general population and is mostly self-limiting. Back pain can be classified as acute, subacute, or chronic depending on the duration of symptoms. The wide variety of potential etiologies include degenerative, mechanical, malignant, infectious, rheumatologic, and extraspinal causes. Back Pain (signifies perforation or mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis)
    • Rebound abdominal pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain and rigidity (suggests peritonitis)
  • Other features signifying extensive injury:
    • Fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever
    • Respiratory distress
    • Shock (e.g., hypotension Hypotension Hypotension is defined as low blood pressure, specifically < 90/60 mm Hg, and is most commonly a physiologic response. Hypotension may be mild, serious, or life threatening, depending on the cause. Hypotension, tachycardia)
    • Altered mental status
    • Deaths commonly from perforation and mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis

Diagnosis

  • Attempt to identify the specific agent ingested:
    • Concentration
    • pH
    • Quantity 
  • Laboratory tests:
    • Tests:
      • CBC
      • Comprehensive metabolic panel including ionized calcium
      • Lactate
      • Toxicology screening
      • Blood gas
      • CRP
    • Findings:
      • Leukocytosis, low platelet count, severe acidosis, elevated CRP, renal failure, and liver Liver The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood. Liver-function abnormalities are indicative of poor outcomes.
      • Abrupt, life-threatening hypocalcemia Hypocalcemia Hypocalcemia, a serum calcium < 8.5 mg/dL, can result from various conditions. The causes may include hypoparathyroidism, drugs, disorders leading to vitamin D deficiency, and more. Calcium levels are regulated and affected by different elements such as dietary intake, parathyroid hormone (PTH), vitamin D, pH, and albumin. Presentation can range from an asymptomatic (mild deficiency) to a life-threatening condition (acute, significant deficiency). Hypocalcemia can occur with the ingestion of hydrogen fluoride.
  • ECG ECG An electrocardiogram (ECG) is a graphic representation of the electrical activity of the heart plotted against time. Adhesive electrodes are affixed to the skin surface allowing measurement of cardiac impulses from many angles. The ECG provides 3-dimensional information about the conduction system of the heart, the myocardium, and other cardiac structures. Normal Electrocardiogram (ECG): Check for ischemia and/or arrhythmia.
  • Imaging:
    • X-ray:
      • Chest: Check for pneumomediastinum, aspiration pneumonia Pneumonia Pneumonia or pulmonary inflammation is an acute or chronic inflammation of lung tissue. Causes include infection with bacteria, viruses, or fungi. In more rare cases, pneumonia can also be caused through toxic triggers through inhalation of toxic substances, immunological processes, or in the course of radiotherapy. Pneumonia, and presence of a foreign body (e.g., battery).
      • Abdominal: Check for pneumoperitoneum and presence of a foreign body. 
    • CT scan: 
      • Check the depth of necrosis. 
      • Determines presence of perforation and helps assess the need for emergency surgery
  • Upper endoscopy:
    • 1st step is to stabilize the patient.
    • Contraindicated in hemodynamic instability and GI perforation
    • Preferably within 24 hours (average 12–48 hours)
    • Early endoscopy may not correctly indicate the extent of injury, while delayed endoscopy increases the risk of perforation.
    • Pathological classification of injury:
      • 1st-degree injury: superficial mucosa affected; erythema, edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema, hemorrhage expected during healing
      • 2nd-degree injury: ulcers, exudates affect up to submucosal layer; scarring and strictures possible
      • 3rd-degree injury: transmural in depth, with deep ulcers and wall perforation

Management and Complications

Management

Asymptomatic patients without significant ingestion or oral burns Burns A burn is a type of injury to the skin and deeper tissues caused by exposure to heat, electricity, chemicals, friction, or radiation. Burns are classified according to their depth as superficial (1st-degree), partial-thickness (2nd-degree), full-thickness (3rd-degree), and 4th-degree burns. Burns can be safely discharged.

Management of symptomatic patients and individuals with significant ingestion includes the following:

  • Secure airway (laryngoscopy).
  • Fluid resuscitation and pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain control
  • Decontamination (remove clothes, skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin irrigation) 
  • No nasogastric intubation
  • Medications:
    • Use IV proton pump inhibitors.
    • Avoid emetics (vomiting worsens burn/injury) and use neutralizing agents or corticosteroids.
  • Mild injury needs only supportive management.
  • More severe injury:
    • Observe for signs of perforation.
    • May require tube feedings 
    • Possible surgery ( laparotomy Laparotomy Laparotomy is an open surgical exploration of the abdomen, usually through a single large incision. Laparotomy and Laparoscopy and esophagectomy)

Complications

  • Airway/cardiorespiratory:
    • Airway edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema or obstruction may occur immediately or up to 48 hours after exposure.
    • Mediastinitis
    • Pericarditis Pericarditis Pericarditis is an inflammation of the pericardium, often with fluid accumulation. It can be caused by infection (often viral), myocardial infarction, drugs, malignancies, metabolic disorders, autoimmune disorders, or trauma. Acute, subacute, and chronic forms exist. Pericarditis
    • Pleuritis Pleuritis Pleuritis, also known as pleurisy, is an inflammation of the visceral and parietal layers of the pleural membranes of the lungs. The condition can be primary or secondary and results in sudden, sharp, and intense chest pain on inhalation and exhalation. Pleuritis
  • Gastroenterological:
    • Gastroesophageal perforation occurring with a possible delay of 4 days (up to 3 weeks) post ingestion
    • Formation of esophageal stricture:
      • Most common complication
      • May be prevented by dilatation or stenting after 3–4 weeks
    • Fistula formation:
    • Upper GI hemorrhage and ulcers
    • Peritonitis
    • ↑ Risk of squamous cell carcinoma Squamous cell carcinoma Cutaneous squamous cell carcinoma (cSCC) is caused by malignant proliferation of atypical keratinocytes. This condition is the 2nd most common skin malignancy and usually affects sun-exposed areas of fair-skinned patients. The cancer presents as a firm, erythematous, keratotic plaque or papule. Squamous Cell Carcinoma (SCC) with lye ingestion (surveillance upper endoscopy after 15–20 years to screen for SCCs)

Differential Diagnosis

  • Esophageal cancer Esophageal cancer Esophageal cancer is 1 of the most common causes of cancer-related deaths worldwide. Nearly all esophageal cancers are either adenocarcinoma (commonly affecting the distal esophagus) or squamous cell carcinoma (affecting the proximal two-thirds of the esophagus). Esophageal Cancer: a malignant tumor of the esophagus Esophagus The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part. Esophagus. Nearly all esophageal cancers are either adenocarcinomas or SCCs. Early-stage cancer is often asymptomatic, with dysphagia Dysphagia Dysphagia is the subjective sensation of difficulty swallowing. Symptoms can range from a complete inability to swallow, to the sensation of solids or liquids becoming "stuck." Dysphagia is classified as either oropharyngeal or esophageal, with esophageal dysphagia having 2 sub-types: functional and mechanical. Dysphagia and weight loss presenting as the disease progresses. Diagnosis of esophageal cancer is by endoscopic biopsy or image-guided biopsy of the metastatic site. Management depends on the disease stage. Alkali ingestion is a risk factor for SCC.
  • Esophageal stricture: an abnormal narrowing in the esophagus Esophagus The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part. Esophagus, which might occur due to benign or malignant conditions. Benign (non-cancerous) strictures may occur due to the buildup of fibrous tissue and collagen deposits from ulcers, or chronic inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation of the esophagus Esophagus The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part. Esophagus.
  • Esophagitis Esophagitis Esophagitis is the inflammation or irritation of the esophagus. The major types of esophagitis are medication-induced, infectious, eosinophilic, corrosive, and acid reflux. Patients typically present with odynophagia, dysphagia, and retrosternal chest pain. Esophagitis: inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation or irritation of the esophagus Esophagus The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part. Esophagus. The major variants of esophagitis are medication-induced, infectious, eosinophilic, corrosive, and acid-reflux esophagitis. Patients typically present with odynophagia, dysphagia Dysphagia Dysphagia is the subjective sensation of difficulty swallowing. Symptoms can range from a complete inability to swallow, to the sensation of solids or liquids becoming "stuck." Dysphagia is classified as either oropharyngeal or esophageal, with esophageal dysphagia having 2 sub-types: functional and mechanical. Dysphagia, and retrosternal chest pain Chest Pain Chest pain is one of the most common and challenging complaints that may present in an inpatient and outpatient setting. The differential diagnosis of chest pain is large and includes cardiac, gastrointestinal, pulmonary, musculoskeletal, and psychiatric etiologies. Chest Pain. Diagnosis is by endoscopy and biopsy. Management depends on the etiology, but includes medications and possible surgery.
  • Herbicides: substances used to control the growth of unwanted plants and in the construction industry. Paraquat is an example of an herbicide that is potentially fatal when ingested. Clinical manifestations range from local oral burns Burns A burn is a type of injury to the skin and deeper tissues caused by exposure to heat, electricity, chemicals, friction, or radiation. Burns are classified according to their depth as superficial (1st-degree), partial-thickness (2nd-degree), full-thickness (3rd-degree), and 4th-degree burns. Burns to vomiting, diarrhea Diarrhea Diarrhea is defined as ≥ 3 watery or loose stools in a 24-hour period. There are a multitude of etiologies, which can be classified based on the underlying mechanism of disease. The duration of symptoms (acute or chronic) and characteristics of the stools (e.g., watery, bloody, steatorrheic, mucoid) can help guide further diagnostic evaluation. Diarrhea, renal failure, and respiratory distress. Early detection (based on history) is important to prevent further toxicity. Management depends on the ingested quantity and time since exposure. Hemodialysis is recommended in certain cases.
  • Pesticides: chemical substances used to control pests, including weeds. Commonly used pesticides include organochlorines, carbamates, and organophosphates. Ingestion of different pesticides result in different clinical manifestations, which include nausea, vomiting, and neurotoxicity. Early detection after exposure is important to prevent further toxicity. Management involves supportive therapy and may include antidotes depending on the ingested pesticide.

References

  1. De Lusong, M., Timbol, A., & Tuazon, D. (2017). Management of esophageal caustic injury. World Journal of Gastrointestinal Pharmacology and Therapeutics, 8(2), 90–98. https://doi.org/10.4292/wjgpt.v8.i2.90
  2. Dire, D. (2020). Disk Battery Ingestion. Emedicine. Retrieved March 15, 2021, from https://emedicine.medscape.com/article/774838-overview
  3. Lung, D. (2020). Caustic Ingestions Clinical Presentation. Emedicine. Retrieved March 14, 2021, from https://emedicine.medscape.com/article/813772-clinical
  4. Triadafilopoulos, G. (2020). Caustic esophageal injury in adults. UpToDate. Retrieved March 15, 2021, from https://www.uptodate.com/contents/caustic-esophageal-injury-in-adults

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