Caustic substance poisoning

If caustic substances (strong acids and alkalis) are ingested, they can burn the mouth, tongue, esophagus and stomach. These burns can result to perforations of the esophagus or stomach. Food and saliva that leaks from the perforation can cause severe or oftentimes fatal infection inside the chest or abdomen. The burns that do not perforate can lead to scarring of the esophagus as well as the stomach.

Remember that industrial products are the most destructive since they are very concentrated. Nevertheless, some common household products including toilet and drain cleaners and some dishwashing detergents usually contain damaging caustic substances such as sulfuric acid and sodium hydroxide.

The caustic substances are available as liquids and solids. The burning sensation of a solid particle that adheres to a moist surface can prevent the individual from ingesting too much of the product. Since liquids do not stick, it is easier to consume more and the entire esophagus is damaged. In addition, liquids might be inhaled into the airways, thus resulting to upper airway injury.

What are the indications of caustic substance poisoning?

  • Pain in the mouth and throat that occurs rapidly, usually in minutes and can be severe especially while swallowing
  • Cough and drooling
  • Difficulty swallowing
    Caustic substance poisoning
    Pain in the mouth and throat that occurs rapidly, usually in minutes and can be severe especially while swallowing.
  • Vomiting
  • Shortness of breath
  • Blood-streaked vomitus

In severe cases which involves highly caustic substances, the individual might develop very low blood pressure, chest pain or difficulty breathing that can possibly lead to death. Burns in the airway can cause rapid breathing, coughing or shortness of breath.

The perforation of the stomach or esophagus can occur within hours during the initial week after ingestion or any time in between, usually after vomiting or severe coughing. The esophagus might perforate into the region between the lungs or into the neighboring area of the lungs.

Scarring of the esophagus can lead to narrowing which causes difficulty swallowing. This can develop weeks after the burn, oftentimes in burns that initially caused mild symptoms.

Management

The mouth is assessed for any chemical burns. Since both the esophagus and stomach might be burned without the mouth involved, the doctor might insert a flexible tube down the esophagus, especially if the individual is drooling or has difficulty swallowing. Direct inspection will allow the doctor to determine the severity of the damage and predict the possibility of subsequent narrowing and the need for surgery of the esophagus.

In cases involving extensive burns, immediate surgery is required to eliminate the severely damaged tissue.

Since caustic substances are capable of causing damage when returning up in the esophagus similar to when they were ingested, it is not advisable to urge the individual to vomit.

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