Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 38-17: Alkalies Poisoning + Key Features Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ Radiographs may reveal evidence of perforation or the presence of radiopaque disk batteries in the esophagus, stomach or intestines + Treatment Download Section PDF Listen +++ ++ 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