**example agents**: ammonia, potassium hydroxide, sodium hydroxide, sodium hypochlorite, hydrochloric acid, sulfuric acid, paraquat, phenols, potassium permanganate, mercuric chloride, zinc chloride See also: [[Hydrofluoric Acid]] > [!TLDR] Overview > - ingestion of corrosive agents causes injury to the **upper airway** and **GI tract**. > - upper airway injury is a life-threatening emergency > - **Endoscopy** and CT scanning stratify risk for delayed sequelae in symptomatic patients > - Signs and symptoms correlate poorly wiht the extent of gastro-oesophagel injury > - stridor, dysphonia, or dysphagia indicate potential imminent airway compromise **Acids** - cause coagulation necrosis - eschar formation stops progression **Alkali** - more common - liquefaction necrosis facilitates progression - full thickness injury # Sources Ammonia - anti rust, metal cleaners HCL - metal cleaners sodium hydroxide - [[Button Batteries]], detergents, drain and oven cleaners sodium hypochlorite - bleaches and household cleaners sulfuric acid - automotive batteries, drain cleaners # Risk assessment - H2SO4 (sulfuric acid), NaOH (sodium hydroxide) associated with severe corrosive injury to pharynx and upper airway, oesophagus, and stomach. - NOT associated with systemic toxicity - stridor, dysponea, dysphonia, or throat pain indicates airway injury and an immediate threat to life - significant gastro-oesophageal injury indicated by any two of the following: - stridor - drooling - vomiting \>60mL hydrochloric acid leads to severe injury to stomach and duodenum, multi organ systemic failure, usually fatal < 150mL household bleach does not usually cause significant corrosive injury ==the absence of lip or oral burns does not exclude significant gastro-oesophagel injury== Following are associated with severe systemic toxicity: - glyphosate - mercuric chloride - paraquat - potassium permanganate - zinc # Paeds corrosive ingestions - unintential ingestion of household drain and oven cleaners or automatic dishwashing powerders can cause severe corrosive injury - inintestinal ingestion of household bleach is usually benign - ingested [[Button Batteries]] may cause corrosive injury if they lodge in the oesophagus # Clinical Features - pain in mouth and throat - drooling - stridor, hoarseness, resp distress - oesophageal perforation and mediastinitis a/w chest pain, dysponea, fever, s/c emphysema - stomach perf can cause peritonitis - patients who ingest large amounts of concentrated acids usually present in shock with profound metabolic acidosis and progress to multi-organ failure and death despite laparotomy and surgical debridement of necrotic tissue ## Grading of injury on endoscopy or CT **Endoscopic grading** - Grade 0 : Normal - Grade I : Mucosal oedema and hyperaemia - Grade IIA : Superficial ulcers, bleeding and exudates - Grade IIB : Deep focal or circumferential ulcers - Grade IIIA : Focal necrosis - Grade IIIB: Extensive necrosis **CT grading** - Grade 0 : normal appearance - Grade I : oedematous wall thickening - Grade II : Grade I and soft tissue infiltration - Grade III : Grade II + air bubbles in organ wall, free mediastinal or peritoneal air or fluid collection # Management - early potential threat is **rapid onset of upper airway oedema and compromise** - ==early intubation or surgical airway may be required== - do NOT insert NGT until after endoscopy - analgesia - NBM - urgent surgical intervention - no evidence ofr steroids; may increase mortality ## Paraquat Incredibly fatal - immediate and aggressive supportive care - Airway - Prevent further absorption - ​lavage if < 2 hours following ingestion - ==Fuller’s earth== (clay based soil) → binds and inactivates paraquot. dose of 1,000 mL 15 - 30% aqueous solution - Activated charcoal if this isn’t available 1-2g/kg - Can just give soil mixed with water and have them drink it **time critical priority!** - Kitchen sink therapies: - [[N-acetyl-cysteine|NAC]] - Dexamethasone 8mg ## decontamination - rinse mouth as first aid - do not give oral fluids, do not induce vomiting, do not give activated charcoal, dont attempt pH neutralisation # Disposition - symptomatic patients remain NBM and admitted for observation and investigation within 24 hours - urgent surgical intervention if unstable or evidence of GI perforation - If paraquot, if well and two -ve dithionite tests 6 hours apart prob didn’t have any paraquot