- Car battery fluid (sulfuric acid)
- Descalers (hydrochloric acid)
- Metal cleaners (nitric acid)
- Rust removers (hydrogen fluoride)
- Bleach (hypochlorite)
- Sodium hydroxide (liquid lye)
0 Normal mucosa
2a Superficial ulcer/erosion/friability/hemorrhage/
2b Findings in 2a + deep discrete/circumferential
3a Scattered necrosis (black/grey discoloration)
3b Extensive/circumferential necrosis of mucosa
2. Major Ingestion
- Pay special attention to the Airway/Oxygenation
- IV Fluids
- Add PPIs (reduce exposure of injured esophagus to gastric acid, which may result in decreased stricture formation.)
- Antibiotics if there is evidence of perforation
- Don't forget to add pain relief
- Keep Nil by Mouth
- Induce Emesis (risk of mucosal injury and perforation)
- Insert NG Tube (may cause esophageal perforation and increase the risk of aspiration)
- Do Lavage (risk of damage to oesophagus and aspiration)
- Try to neutralise the substance (risk of heat production resulting from this exothermic reaction
- Administer systemic steroids
Within 48-72 hours of corrosive ingestion: Upper GI endoscopy should be performed on Day 1-2. (ideally between 12-24 hours of ingestion). If endoscopy reveals only mild lesions, then the patient can be discharged and clinical follow-up should be done at one month. If severe lesions are found on endoscopy, then surgical gastrostomy is indicated, which should be followed by repeat endoscopy and dilatation after three weeks.
Within 72 hours to three weeks of corrosive ingestion: No endoscopy is indicated here. Gastrostomy should be done if there is severe dysphagia. Endoscopy and dilatation of stricture (if present) should be done three weeks after ingestion.
- Dilatation therapy: This is done 3-6 weeks after injury, progressively larger bougies are passed over endoscopically placed guide wires for dilatation.
- Surgery: Esophageal strictures resistant to dilatation therapy may require surgery that includes resection of stricture surgically and esophageal bypass surgery.
For further reading:
- In: Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient. 1st edition, Brent, Wallace, Burkhart, Phillips, Donovan (Eds.) 2005:p. 1035-44.
- Caustics. In: Goldfrank’s Toxicologic Emergencies. 8th edition.
- Zargar SA, Kochhar R, Mehta S, Mehta SK. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc 1991;37(2):165-9.
- Anderson KD, Rouse TM, Randolph JG. A controlled trial of corticosteroids in children with corrosive injury of the esophagus. N Engl J Med 1990;323(10):637-40.
- Acids and alkalis. The Poisoning and Toxicology Handbook. 4th edition, Jerrold B. Leikin, Frank P. Paloucek Informa Healthcare, USA 2007:p.713-9.
- Alkali injury. In: Clinical Management of Poisoning and Drug Overdose. 3rd edition, Lester M. Haddad, Michael W. Shannon, and James F. Winchester (Eds.) 1998: p.817-20.