HWN Suggests

Caustic Ingestions: hide your bleach or hide your kids

The presence or absence of any clinical symptoms does not predict/exclude the degree of esophageal or gastric injury. Moreover, don’t just rely on the physical exam. The presence/absence of oral lesions or burns is not a good predictor of esophageal injury.

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 Tide Pod Challenge: Managing caustic laundry pod ingestions

Laundry pods are composed of an external dissolvable polyvinyl alcohol membrane that dissolves with contact with water (or saliva). Inside the membrane is a proprietary alkaline mixture of chemicals, containing toxic alcohols (like propylene glycol), surfactants and long chain polymers. This mixture can cause damage through ocular and dermal contact, but ingestion is far more common, with 90% of exposures having ingestion as one of the routes. The toxic effects span a variety of systems,

 When is emergency endoscopy required for caustic ingestions?

This study has encouraged me to be more vigilant in older patients who have swallowed caustic substances. To a lesser extent, it has also encouraged me to be more careful with accidental ingestions, which appear to share equal risk with deliberate ingestions. I would have guessed before reading this study that patients who drink corrosive agents with suicidal intent are likely to swallow a higher volume, and incur more significant burns. This is, perhaps, not the case. At present, NPIS do not recommend that ED clinicians refer asymptomatic patients for OGD after caustic ingestion. This study provides no evidence to contradict this guidance.

Articles of Interest

Acute Caustic Ingestion: State of Art and New Trends

The ingestion of caustic substances, both accidental and voluntary, determines a complex syndrome, characterized by severe, often irreversible, visceral lesions, with still remarkable mortality in highly compromised patients. The most severe esophageal and gastric damage is notoriously related to voluntary and pseudo-voluntary ingestion of high amount or concentration of strong acids or alkali compounds.

Annals of B-Pod: Caustic Ingestions

Ingestion of detergent agents, whether intentional or accidental, can cause serious and potentially life-threatening toxicologic disease. While ingestion in the adult population often stems from psychiatric disease or self-injurious behaviors, the advent of water-soluble laundry detergent pods has led to a significant increase in the number of pediatric poisonings, due in part to their bright coloration and pleasant smell.

Caustic ingestion

Corrosive ingestion is a rare but potentially devastating event and, despite the availability of eff ective preventive public health strategies, injuries continue to occur. Most clinicians have limited personal experience and rely on guidelines; however, uncertainty persists about best clinical practice. Ingestions range from mild cases with no injury to severe cases with full thickness necrosis of the oesophagus and stomach. CT scan is superior to traditional endoscopy for stratifi cation of patients to emergency resection or observation.

Caustic Ingestions: Feel the Burn

Patients present with signs and symptoms ranging from minor nausea/vomiting to concerning physical examination findings including stridor, dysphagia, drooling, oropharynx ulcerations, soft tissue edema, and refractory pain. It is important to note that ingestion injuries continue to evolve after initial presentation so frequent reexamination is warranted.

Emergency Management of Caustic Injuries

A nonoperative approach can be offered to 70–80 % of patients after caustic ingestion. Patients eligible for nonoperative treatment may resume oral alimentation as soon they can swallow. After control of the psychiatric condition, patients with minor digestive tract involvement can be discharged as soon as they eat normally.

Evidence-Based Management Of Caustic Exposures In The Emergency Department

The presence or absence of oral findings on physical examination is not a reliable marker to predict the presence or absence of distal gastrointestinal tract injury.

Ingestion of Caustic Substances

After caustic ingestion, a person’s most immediate risk to life is loss of the airway, which can occur from direct contact during swallowing or emesis or from edema that extends locally from an injured esophagus.

The Weekly Cheese: The Caustic Ingestion

Pediatric patients tend have small exploratory ingestions with more benign presentations compared to adolescents and adults with large-volume intentional ingestions. But stay vigilant for non-accidental trauma. Children shouldn’t be able to unscrew a lid before they are ~2 years of age.

ToxCard: Caustic Ingestions – Do’s and Don’ts of Diagnosis and Management

Patients often present with clinical evidence of tissue damage either in their oropharynx, esophagus, or airway. However, it is possible to not have any initial physical findings and still have a significant injury in the non-visualized sections of the gastrointestinal tract.