Ingestion of Caustic or Corrosive Agents

Description

Diagnostic criteria

General and supportive measures

Medicine treatment

Referral

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ICD-10 code: T54

DESCRIPTION

Alkalis, e.g. sodium hydroxide, potassium permanganate.

Acids, e.g. hydrochloric acid.

The severity of the injury is dependent on the concentration and duration of exposure to the acid or alkali.

DIAGNOSTIC CRITERIA

Clinical

• Chief symptom is pain.
• Young children may present with:
  • crying,
  • refusal to swallow,
  • drooling,
  • vomiting.
• Stridor or hoarseness indicates laryngeal injury.
• The presence of oral or pharyngeal burns does not predict the presence of oesophageal or gastric injury.
• Oesophageal or gastric injury can cause perforation or subsequent fistula formation.
• Asymptomatic patients are unlikely to have significant oesophageal or gastric injury.

GENERAL AND SUPPORTIVE MEASURES

Asymptomatic

• Monitor for development of symptoms.
  • A 12-hour symptom-free period usually indicates that no intervention is necessary.

Symptomatic

• Gastric lavage/emesis/activated charcoal are contraindicated in all cases.
• Keep patient nil per mouth.
• Insertion of a NGT is contraindicated.
• Airway injury may necessitate endotracheal intubation.
• Endoscopic evaluation.

MEDICINE TREATMENT

• Prophylactic antibiotics are not indicated.
• Empiric steroid therapy is not indicated, however, based on endoscopy findings, may be appropriate (sub-specialist initiated).

For pain control:

• See: Pain Control, Management of pain.

REFERRAL 

• All symptomatic cases for endoscopic evaluation as soon as possible.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition

Chapter 18: Poisoning,  18.1 Poisoning,  18.1.4 Ingestion Of Caustic Or Corrosive Agents