Daily Bolus of LR: Caustic Ingestions

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March 4, 2011 by dailybolusoflr

Caustic Ingestions

 

Caustic ingestions in children are more likely to be accidental while in adults they are more likely to be intentional.

 

Alkali ingestions are more concerning than acid ingestions

o   Acid ingestions:

§  Coagulation necrosis

§  More severe stomach injury

§  Typically eschar forms over the injured area and these patients are at high risk for bleeding and/or perforation when this eschar falls off around 2-3 days.

o   Alakali ingestions:

§  Liquefaction necrosis

§  More severe esophageal injury, as well as the pharyngeal tissues, as these are the earliest structures encountered.

§  Most frequent serious early complication is esophageal perforation

§  Most frequent serious late complication is esophageal stricture

 

Focus on:

·         The airway due to intrinsic injury or compression related to edema of surrounding structures.

·         Hemodynamic status related to perforation, bleeding, shock.

·         Identifying agent if possible.

 

 

Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions

 

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