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Caustics are substances that cause both functional and histologic damage on contact with body surfaces. Many household and industrial chemicals have caustic potential. Caustics are often broadly classified as alkalis (pH >7) or acids (pH <7). In developed nations, increased education and product regulation have led to significantly decreased morbidity and mortality from caustic exposures. However, in underdeveloped parts of the world, exposure to caustics remains a significant problem.1–3 In 2008, the American Association of Poison Control Centers received reports of more than 130,000 potentially caustic exposures in the U.S., including dermal and ocular exposure as well as intentional and unintentional oral exposures.4 Caustic exposures tend to fall to three distinct groups: (1) intentional teen or adult ingestions with suicidal intent; (2) unintentional exposures (the majority of which are by curious children in the toddler age group); and (3) other incidental, often occupational exposures. The majority of reported exposures were unintentional or accidental. Although less frequent, intentional ingestions account for the majority of serious injuries. For example, in Sierra Leone, most of the reported 260 exposures that resulted in major morbidity and the 21 that resulted in death were intentional exposures.1

Many chemicals used in industry have caustic potential. Alkali substances used in industry include sodium hydroxide (lye) and potassium hydroxide in cleaning fluids, calcium hydroxide in concrete, lithium hydroxide in photography, and ammonium hydroxide in fertilizers. Common acids used in industry include hydrochloric acid and sulfuric acids as cleaners, hydrofluoric acid in etching and metal cleaning, chromic acid in metal plating, and formic acid in leather/textile tanning (Table 194-1).

Table 194-1 Common Caustic Compounds

Household caustics are often less concentrated forms of industrial strength cleansers. Alkali caustics found in the home include sodium hydroxide in drain openers, oven cleaners, and copper sulfate reagent tablets used to monitor urinary sugar in diabetics (Table 194-1). Caustic ammonium compounds are found in glass, tub, and tile cleaners. Household bleach (sodium hypochlorite) is the most common alkali exposure reported to the American Association of Poison Control Centers, accounting for about 37,000 exposures in 2008.4 Most bleach exposures are benign, but 23 patients suffered major morbidity and two deaths were reported in 2008.4 Common household acids include sulfuric acid in drain cleaners and automobile batteries, hydrochloric acid in toilet bowl ...

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