What are complications of caustic ingestions?

Updated: Dec 09, 2020
  • Author: Derrick Lung, MD, MPH, FACEP, FACMT; Chief Editor: David Vearrier, MD, MPH  more...
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Answer

Immediate, general complications of caustic and corrosive exposures may include airway edema or obstruction, which may occur immediately or up to 48 hours following an alkaline exposure. Gastroesophageal perforation and upper gastrointestinal hemorrhage may occur acutely in caustic exposure. Secondary complications include the following:

  • Mediastinitis
  • Pericarditis
  • Pleuritis
  • Tracheoesophageal fistula formation
  • Esophageal-aortic fistula formation
  • Peritonitis

Disk batteries deserve special attention because they can adhere to the esophageal or gastric mucoa, leading to perforation due to prolonged contact with extruded substances and residual electric discharge. See Disk Battery Ingestion for a detailed discussion.

Delayed perforation may occur as many as 4 days after an acid exposure. Delayed upper GI bleeding may occur in acid burns 3-4 days after exposure as the eschar sloughs. Deep circumferential or deep focal burns may result in strictures in more than 70% of patients; these strictures typically develop 2-4 weeks postingestion. Gastric outlet obstruction may develop 3-4 weeks after an acid exposure.

Some agents have the ability to cause systemic toxicity that affects the prognosis in addition to their caustic properties. These include the following:

  • Phenol
  • Zinc chloride
  • Mercuric chloride
  • Hydrogen fluoride
  • Oxalic acid
  • Detergent pods

In pediatric patients, detergent pods have been observed to sometimes cause altered mental status and lactic acidosis, hypothesized to be due to their ingredients of propylene glycol and or alcohol ethoxylates.

Cardiac arrest from sudden hypocalcemia may occur in patients who have ingested hydrogen fluoride–containing substances. Patients have been successfully resuscitated with aggressive use of intravenous calcium chloride.

Long-term risks include squamous cell carcinoma, which occurs in 1-4% of all significant exposures and may occur as late as 40 years after exposure.

The alkali drain cleaners and acidic toilet bowl cleaners are responsible for the most fatalities from corrosive agents. In adults, 10% of caustic ingestions result in death. [7]

Approximately 10% of caustic ingestions result in severe injury requiring treatment. Approximately 1-2% of caustic ingestions result in stricture formation. [7]


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