Poisoning With Caustic Substances
Caustic substances (strong acids and alkalies), when swallowed, can burn the tongue, mouth, esophagus, and stomach. These burns may cause perforation (piercing) of the esophagus or stomach. Food and saliva leaking from a perforation cause severe, sometimes deadly infection within the chest (mediastinitis or empyema) or abdomen (peritonitis). Burns that do not perforate can result in scarring of the esophagus and stomach.
Industrial products are usually the most damaging because they are highly concentrated. However, some common household products, including drain and toilet bowl cleaners and some dishwasher detergents, contain damaging caustic substances, such as sodium hydroxide and sulfuric acid.
Caustic substances are available as solids and liquids. The burning sensation of a solid particle sticking to a moist surface (such as the lips) may prevent a person from consuming much of the product. Because liquids do not stick, it is easier to consume more of the product, and the entire esophagus can be damaged.
Symptoms
Pain in the mouth and throat develops rapidly, usually within minutes, and can be severe, particularly with swallowing. Coughing, drooling, an inability to swallow, and shortness of breath may occur. In severe cases involving strong caustic substances, a person may develop very low blood pressure (shock), difficulty breathing, or chest pain, possibly leading to death.
Perforation of the esophagus or stomach may occur during the first week after ingestion, often after vomiting or severe coughing. The esophagus may perforate into the area between the lungs (the mediastinum) or into the area surrounding the lungs (the pleural cavity). Either circumstance causes chest pain, fever, rapid heart rate, very low blood pressure, and the development of an abscess (a collection of pus) that requires surgery. Peritonitis results in severe abdominal pain.
Scarring of the esophagus results in narrowing (stricture), which causes difficulty in swallowing. Strictures usually develop weeks after the burn, sometimes in burns that initially caused only mild symptoms.
Diagnosis and Treatment
The mouth is examined for chemical burns. Because the esophagus and stomach may be burned without the mouth being burned, the doctor may insert an endoscope (a flexible viewing tube) down the esophagus to look for burns, particularly if the person drools or has difficulty swallowing. Directly inspecting the area allows the doctor to determine the severity of the injury and possibly to predict the risk of subsequent narrowing and the possible need for surgical repair of the esophagus.
The extent of damage determines treatment. People with severe burns sometimes need immediate surgery to remove severely damaged tissue. Corticosteroids and antibiotics are used to try to prevent strictures and infections, but whether these drugs are helpful is not clear.
Because caustic substances can cause as much damage returning up the esophagus as they did when swallowed, a person who has swallowed a caustic substance should not be made to vomit.
If burns are mild, the person may be encouraged to begin drinking fluids fairly soon during recovery. Otherwise, fluids are given intravenously until drinking is possible. If strictures develop, a bypass tube (stent) may be placed in the narrowed portion of the esophagus to prevent esophageal closure and to allow for future widening (dilation). Repeated widening may be needed for months or years. For severe strictures, surgery to rebuild the esophagus may also be necessary.
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