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Key Features

  • Strong alkalies are common ingredients of some household cleaning compounds and may be suspected by their "soapy" texture

  • Those with alkalinity above pH 12.0 are particularly corrosive

  • Disk (or "button") batteries are also a source

  • Alkalies cause liquefactive necrosis, which is deeply penetrating

Clinical Findings

  • Burning pain in the upper gastrointestinal tract

  • Nausea, vomiting

  • Difficulty in swallowing, breathing, and speaking

  • Examination reveals destruction and edema of the affected skin and mucous membranes and bloody vomitus and stools

Diagnosis

  • Radiographs may reveal evidence of perforation or the presence of radiopaque disk batteries in the esophagus, stomach or intestines

Treatment

  • Ingestion

    • Dilute immediately with a glass of water

    • Do not induce emesis

    • In patients with ingestion of liquid caustic substances,

      • Some gastroenterologists recommend immediate cautious placement of a small flexible gastric tube and removal of stomach contents followed by gastric lavage to remove residual material

      • However, others argue that passage of a gastric tube is contraindicated due to the risk of perforation or reexposure of the esophagus to the corrosive material from vomiting around the tube

    • Prompt endoscopy is recommended in symptomatic patients to evaluate the extent of damage; CT scanning may also aid in assessment

    • Immediate endoscopic removal is mandatory for ingested disk batteries in the esophagus

    • Corticosteroids

      • No proven benefit in preventing stricture formation

      • Contraindicated if there is evidence of esophageal perforation

    • Skin contact

      • Wash with running water until the skin no longer feels soapy

      • Relieve pain

      • Treat shock

    • Eye contact

      • Anesthetize the conjunctival and corneal surfaces with topical anesthetic (eg, proparacaine)

      • Irrigate with water or saline continuously for 20–30 minutes, holding the lids open

      • Amphoteric solutions may be more effective than water or saline and are available in Europe (Diphoterine, Prevor)

      • Check pH with pH test paper, and repeat irrigation for additional 30-minute periods until the pH is near 7.0

      • Check for corneal damage with fluorescein and slit lamp examination

      • Consult an ophthalmologist for further treatment

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