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Caustic Ingestion, Emergency Medicine

Paul Kolecki Reviewed 06/2017
 


Basics

Description

  • Alkalis:

    • Dissociate in the presence of H2O to produce hydroxy (OH) ions, which leads to liquefaction necrosis

    • Postingestion—mainly damages the esophagus:

      • Gastric damage can occur (see ...

Diagnosis

Signs and Symptoms

  • Oropharyngeal:

    • Pain

    • Erythema

    • Burns

    • Erosions

    • Ulcers

    • Drooling

    • Hoarseness

    • Stridor

    • Aphonia

    • Absence of visible lesions in the oropharynx does not exclude visceral injuries.

  • Pulmonary:

    • Tachy...

Treatment

Pre-Hospital

  • For oral burns or symptoms: Rinse mouth liberally with water or milk.

  • Water or milk can be given to following patients:

    • Able to drink

    • Not complaining of significant abdominal pain

    • Do...

Follow-Up

Disposition

Admission Criteria

  • All symptomatic patients

  • Nonaccidental ingestion

Discharge Criteria

  • Asymptomatic patients who accidentally ingested and are able to swallow without difficulty

  • Minima...

Pearls and Pitfalls

  • Dilute with milk or water at home or in the ED within the 1st 30 min.

  • Perform copious irrigation of ocular or dermal exposure:

    • Alkalis require more irrigation than acids.

Additional Reading

  • Lupa  M, Magne  J, Guarisco  L, et al. Update on the diagnosis and treatment of caustic ingestions. Ochsner J.  2009;9:54–59.

  • Riffat  F, Cheng  A. Pediatric caustic ingestion: 5...

Codes

ICD9

  • 947.0 Burn of mouth and pharynx

  • 947.2 Burn of esophagus

  • 947.3 Burn of gastrointestinal tract

  • 947.1 Burn of larynx, trachea, and lung

  • 947.8 Burn of other specified sites of internal organs

  • 947.9 B...

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