Alkalies Poisoning

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

• Emergency department visits have increased significantly over the last decade

• 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

  • Use of corticosteroids may be indicated for selected patient populations to prevent stricture formation but is controversial

  • 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