<< Evidence-Based Management Of Caustic Exposures In The Emergency Department


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Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study are included in bold type following the reference, where available. In addition, the most informative references cited in this paper, as determined by the authors, are noted by an asterisk (*) next to the number of the reference.

  1. Mowry JB, Spyker DA, Cantilena LR Jr, et al. 2013 Annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 31st annual report. Clin Toxicol (Phila). 2014;52(10):1032-1283. (Poison control center report)

  2. Hanson M, Hafner JW. In the soup: caustic ingestion from the improper consumption of a self-heating soup. West J Emerg Med. 2012;13(5):426-428. (Case report)

  3. Harley EH, Collins MD. Liquid household bleach ingestion in children: a retrospective review. Laryngoscope. 1997;107(1):122-125. (Retrospective; 19 patients)

  4. Wheeler DS, Bonny AE, Ruddy RM, et al. Late-onset respiratory distress after inhalation of laundry detergent. Pediatr Pulmonol. 2003;35(4):323-325. (Case report)

  5. Vijayanath V, Nagaraja Rao K, Raju GM, et al. Forensic issues in suicide due to acid ingestion in a case of major depressive disorder. Am J Forensic Med Pathol. 2012;33(2):156-158. (Case report)

  6. Bouabdellah S, Hannache K, Roula D, et al. Toxicological, clinical and endoscopic correlation of digestive corrosive injuries in adults. [French]. Acta Endoscopica. 2011;41(4):200-205. (Prospective; 314 patients)

  7. Lupa M, Magne J, Guarisco JL, et al. Update on the diagnosis and treatment of caustic ingestion. Ochsner Journal. 2009;9(2):54-59. (Case report and review)

  8. Araz C, Cekmen N, Erdemli O, et al. Severe gastrointestinal burn with hydrochloric acid. Journal of Research in Medical Sciences. 2013;18(5):449-452. (Case report)

  9. Lionte C, Sorodoc L, Petris OR, et al. Unusual presentation and complication of caustic ingestion. Case report. J Gastrointestin Liver Dis. 2007;16(1):109-112. (Case report)

  10. Matshes EW, Taylor KA, Rao VJ. Sulfuric acid injury. Am J Forensic Med Pathol. 2008;29(4):340-345. (Case report)

  11. Burge M, Hunsaker JC 3rd, Davis GJ. Death of a toddler due to ingestion of sulfuric acid at a clandestine home methamphetamine laboratory. Forensic Sci Med Pathol. 2009;5(4):298-301. (Case report)

  12. Kanne JP, Gunn M, Blackmore CC. Delayed gastric perforation resulting from hydrochloric acid ingestion. AJR Am J Roentgenol. 2005;185(3):682-683. (Case report)

  13. Franke DD, Davis EG, Woods DR, et al. Catastrophic gastrointestinal injury due to battery acid ingestion. J Emerg Med. 2011;40(3):276-279. (Case report)

  14. Lowe JE, Graham DY, Boisaubin EV Jr, et al. Corrosive injury to the stomach: the natural history and role of fiberoptic endoscopy. Am J Surg. 1979;137(6):803-806. (Case report; 5 patients)

  15. Mirji P, Joshi C, Mallapur A, et al. Management of corrosive injuries of the upper gastrointestinal tract. Journal of Clinical and Diagnostic Research. 2011;5(5):944-947. (Prospective; 16 patients)

  16. * Zargar SA, Kochhar R, Mehta S, et al. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc. 1991;37(2):165-169. (Prospective; 81 patients)

  17. Ramasamy K, Gumaste VV. Corrosive ingestion in adults. J Clin Gastroenterol. 2003;37(2):119-124. (Review)

  18.  Salzman M, O’Malley RN. Updates on the evaluation and management of caustic exposures. Emerg Med Clin North Am. 2007;25(2):459-476. (Review)

  19.  Fulton JA. Caustics. In: Nelson LA, Lewin NA, Howland MA, et al, eds. Goldfrank’s Toxicologic Emergencies. 9th ed. New York, New York: McGraw-Hill; 2011:1364-1373. (Textbook)

  20.  * Christesen HB. Prediction of complications following unintentional caustic ingestion in children. Is endoscopy always necessary? Acta Paediatr. 1995;84(10):1177-1182. (Retrospective; 115 patients)

  21. Ryan F, Witherow H, Mirza J, et al. The oral implications of caustic soda ingestion in children. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(1):29-34. (Case report; 3 patients)

  22. * Crain EF, Gershel JC, Mezey AP. Caustic ingestions. Symptoms as predictors of esophageal injury. Am J Dis Child. 1984;138(9):863-865. (Retrospective; 79 patients)

  23. Gupta SK, Croffie JM, Fitzgerald JF. Is esophagogastroduodenoscopy necessary in all caustic ingestions? J Pediatr Gastroenterol Nutr. 2001;32(1):50-53. (Retrospective; 28 patients)

  24. Gaudreault P, Parent M, McGuigan MA, et al. Predictability of esophageal injury from signs and symptoms: a study of caustic ingestion in 378 children. Pediatrics. 1983;71(5):767- 770. (Comparative; 378 patients)

  25. Sugawa C, Lucas CE. Caustic injury of the upper gastrointestinal tract in adults: a clinical and endoscopic study. Surgery. 1989;106(4):802-806. (Case series; 34 patients)

  26. Havanond C, Havanond P. Initial signs and symptoms as prognostic indicators of severe gastrointestinal tract injury due to corrosive ingestion. J Emerg Med. 2007;33(4):349-353. (Prospective; 148 patients)

  27. Gorman RL, Khin-Maung-Gyi MT, Klein-Schwartz W, et al. Initial symptoms as predictors of esophageal injury in alkaline corrosive ingestions. Am J Emerg Med. 1992;10(3):189-194. (Prospective; 336 patients)

  28. Previtera C, Giusti F, Guglielmi M. Predictive value of visible lesions (cheeks, lips, oropharynx) in suspected caustic ingestion: may endoscopy reasonably be omitted in completely negative pediatric patients? Pediatr Emerg Care. 1990;6(3):176- 178. (Prospective observational; 156 patients)

  29. Tewfik TL, Schloss MD. Ingestion of lye and other corrosive agents--a study of 86 infant and child cases. J Otolaryngol. 1980;9(1):72-77. (Retrospective; 86 patients)

  30. Jeng LB, Chen HY, Chen SC, et al. Upper gastrointestinal tract ablation for patients with extensive injury after ingestion of strong acid. Arch Surg. 1994;129(10):1086-1090. (Retrospective; 6 patients)

  31. Cheng YJ, Kao EL. Arterial blood gas analysis in acute caustic ingestion injuries. Surg Today. 2003;33(7):483-485. (Retrospective; 129 patients)

  32. Beasley DM, Schep LJ, Slaughter RJ, et al. Full recovery from a potentially lethal dose of mercuric chloride. J Med Toxicol. 2014;10(1):40-44. (Case report)

  33. Burkhart KK, Kulig KW, McMartin KE. Formate levels following a formalin ingestion. Vet Hum Toxicol. 1990;32(2):135- 137. (Case report)

  34. Dassanayake U, Gnanathasan CA. Acute renal failure following oxalic acid poisoning: a case report. J Occup Med Toxicol. 2012;7(1):17. (Case report)

  35. Eichler HG, Hruby K, Katschnig MJ, et al. [Accidental fatal formaldehyde poisoning]. Wien Klin Wochenschr. 1983;95(7):243-245. (Case report)

  36. Huttel MS. [Disseminated intravascular coagulation after oral ingestion of hydrochloric acid]. Ugeskr Laeger. 1980;142(15):962-963. (Case report)

  37. Haddad LM, Dimond KA, Schweistris JE. Phenol poisoning. JACEP. 1979;8(7):267-269. (Case report)

  38. Kamijo Y, Soma K, Yosimura K, et al. Acute mercuric chloride poisoning: effect of co-ingested milk on outcome and continued hyperamylasemia. Vet Hum Toxicol. 2001;43(5):277- 279. (Case report)

  39. Koppel C, Baudisch H, Schneider V, et al. Suicidal ingestion of formalin with fatal complications. Intensive Care Med. 1990;16(3):212-214. (Case report; 2 patients)

  40. Mao YC, Tsai WJ, Wu ML, et al. Acute hemolysis following iodine tincture ingestion. Hum Exp Toxicol. 2011;30(10):1716- 1719. (Case report)

  41. Lim YC. Acute renal failure following detergent ingestion. Singapore Med J. 2009;50(7):e256-e258. (Case report)

  42. Naik RB, Stephens WP, Wilson DJ, et al. Ingestion of formic acid-containing agents--report of three fatal cases. Postgrad Med J. 1980;56(656):451-456. (Case report; 3 patients)

  43. Newton JA, House IM, Volans GN, et al. Plasma mercury during prolonged acute renal failure after mercuric chloride ingestion. Hum Toxicol. 1983;2(3):535-537. (Case report)

  44. Niki Y, Minakuchi K, Takasu A, et al. [A case of disseminated intravascular coagulopathy (DIC) and multiple organ failure (MOF) after ingestion of hydrochloric acid]. Chudoku Kenkyu. 2001;14(4):335-338. (Case report)

  45. Pesce AJ, Hanenson I, Sethi K. Beta2 microglobulinuria in a patient with nephrotoxicity secondary to mercuric chloride ingestion. Clin Toxicol. 1977;11(3):309-315. (Case report)

  46. Samuels ER, Heick HM, McLaine PN, et al. A case of accidental inorganic mercury poisoning. J Anal Toxicol. 1982;6(3):120-122. (Case report)

  47. Santos O, Restrepo JC, Velasquez L, et al. Acute liver failure due to white phosphorus ingestion. Ann Hepatol. 2009;8(2):162-165. (Case report; 3 patients)

  48. Ward MJ, Routledge PA. Hypernatraemia and hyperchloraemic acidosis after bleach ingestion. Hum Toxicol. 1988;7(1):37- 38. (Case report)

  49. Worth DP, Davison AM, Lewins AM, et al. Haemodialysis and charcoal haemoperfusion in acute inorganic mercury poisoning. Postgrad Med J. 1984;60(707):636-638. (Case report)

  50. Caravati EM. Metabolic abnormalities associated with phosphoric acid ingestion. Ann Emerg Med. 1987;16(8):904-906. (Case report)

  51. Smith E, Liebelt E, Nogueira J. Laundry detergent pod ingestions: is there a need for endoscopy? J Med Toxicol. 2014;10(3):286-291. (Case series; 3 patients)

  52. Lamireau T, Rebouissoux L, Denis D, et al. Accidental caustic ingestion in children: is endoscopy always mandatory? J Pediatr Gastroenterol Nutr. 2001;33(1):81-84. (Prospective; 85 patients)

  53. Appropriate use of gastrointestinal endoscopy. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc. 2000;52(6):831-837. (Consensus practice guideline)

  54. Poley JW, Steyerberg EW, Kuipers EJ, et al. Ingestion of acid and alkaline agents: outcome and prognostic value of early upper endoscopy. Gastrointest Endosc. 2004;60(3):372-377. (Review; 179 patients)

  55. * Zargar SA, Kochhar R, Nagi B, et al. Ingestion of corrosive acids: spectrum of injury to upper gastrointestinal tract and natural history. Gastroenterology. 1989;97:702-707. (Prospective observational; 41 patients)

  56. * 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):637-640. (Prospective randomized controlled trial; 60 patients)

  57. Zwischenberger JB, Savage C, Bidani A. Surgical aspects of esophageal disease: perforation and caustic injury. Am J Respir Crit Care Med. 2002;165(8):1037-1040. (Review)

  58. Ochi K, Ohashi T, Sato S, et al. Surgical treatment for caustic ingestion injury of the pharynx, larynx, and esophagus. Acta Otolaryngol Suppl. 1996;522:116-119. (Case report)

  59. Koschny R, Herceg M, Stremmel W, et al. Fatal course of a suicidal intoxication with hydrochloric acid. Case Rep Gastroenterol. 2013;7(1):89-96. (Case report)

  60. Ryu HH, Jeung KW, Lee BK, et al. Caustic injury: can CT grading system enable prediction of esophageal stricture? Clin Toxicol (Phila). 2010;48(2):137-142. (Comparative retrospective; 49 patients)

  61. Graham CA. Stridor after ingestion of Dettol and Domestos. Eur J Emerg Med. 2004;11(1):52-54. (Case report)

  62. De Groote WJ, Sabbe MB, Meulemans AI, et al. An acute zinc chloride poisoning in a child: was chelator therapy effective? Eur J Emerg Med. 1998;5(1):67-69. (Case report)

  63. McKinney PE, Brent J, Kulig K. Acute zinc chloride ingestion in a child: local and systemic effects. Ann Emerg Med. 1994;23(6):1383-1387. (Case report)

  64. Health hazards associated with laundry detergent pods - United States, May-June 2012. MMWR Morb Mortal Wkly Rep. 2012;61(41):825-829. (Government report)

  65. Huntington S, Heppner J, Vohra R, et al. Serious adverse effects from single-use detergent sacs: report from a U.S. statewide poison control system. Clin Toxicol (Phila). 2014;52(3):220-225. (Retrospective; 804 cases)

  66. Forrester MB. Comparison of pediatric exposures to concentrated “pack” and traditional laundry detergents. Pediatr Emerg Care. 2013;29(4):482-486. (Comparative; 639 exposures)

  67. Beuhler MC, Gala PK, Wolfe HA, et al. Laundry detergent “pod” ingestions: a case series and discussion of recent literature. Pediatr Emerg Care. 2013;29(6):743-747. (Case report; 4 patients)

  68. Lim R, Forward KE. Laundry detergent pod ingestion. Pediatr Emerg Care. 2013;29(9):1053-1054. (Letter to the editor)

  69. Schneir AB, Rentmeester L, Clark RF, et al. Toxicity following laundry detergent pod ingestion. Pediatr Emerg Care. 2013;29(6):741-742. (Case report)

  70. Williams H, Jones S, Wood K, et al. Reported toxicity in 1486 liquid detergent capsule exposures to the UK National Poisons Information Service 2009-2012, including their ophthalmic and CNS effects. Clin Toxicol (Phila). 2014;52(2):136-140. (Prospective observational; 1486 exposures)

  71. Chan BS, Duggin GG. Survival after a massive hydrofluoric acid ingestion. J Toxicol Clin Toxicol. 1997;35(3):307-309. (Case report)

  72. Klasaer AE, Scalzo AJ, Blume C, et al. Marked hypocalcemia and ventricular fibrillation in two pediatric patients exposed to a fluoride-containing wheel cleaner. Ann Emerg Med. 1996;28(6):713-718. (Case report; 2 patients)

  73. Whiteley PM, Aks SE. Case files of the Toxikon Consortium in Chicago: survival after intentional ingestion of hydrofluoric acid. J Med Toxicol. 2010;6(3):349-354. (Case report)

  74. Cordero SC, Goodhue WW, Splichal EM, et al. A fatality due to ingestion of hydrofluoric acid. J Anal Toxicol. 2004;28(3):211-213. (Case report)

  75. Manoguerra AS, Neuman TS. Fatal poisoning from acute hydrofluoric acid ingestion. Am J Emerg Med. 1986;4(4):362-363. (Case report)

  76. Holstege C, Baer A, Brady WJ. The electrocardiographic toxidrome: the ECG presentation of hydrofluoric acid ingestion. Am J Emerg Med. 2005;23(2):171-176. (Case report)

  77. Kao WF, Dart RC, Kuffner E, et al. Ingestion of low-concentration hydrofluoric acid: an insidious and potentially fatal poisoning. Ann Emerg Med. 1999;34(1):35-41. (Retrospective; 1772 exposures)

  78. Bost RO, Springfield A. Fatal hydrofluoric acid ingestion: a suicide case report. J Anal Toxicol. 1995;19(6):535-536. (Case report)

  79. Martinez MA, Ballesteros S, Piga FJ, et al. The tissue distribution of fluoride in a fatal case of self-poisoning. J Anal Toxicol. 2007;31(8):526-533. (Case report)

  80. Menchel SM, Dunn WA. Hydrofluoric acid poisoning. Am J Forensic Med Pathol. 1984;5(3):245-248. (Case report)

  81. Antar-Shultz M, Rifkin SI, McFarren C. Use of hemodialysis after ingestion of a mixture of acids containing hydrofluoric acid. Int J Clin Pharmacol Ther. 2011;49(11):695-699. (Case report)

  82. Chanut C, Lô J-M, Bengler C, et al. Fluorhydric acid ingestion: a case report. [French]. Journal Européen des Urgences. 1999;12(4):179-181. (Case report)

  83. Stremski ES, Grande GA, Ling LJ. Survival following hydrofluoric acid ingestion. Ann Emerg Med. 1992;21(11):1396-1399. (Case report)

  84. Su YJ, Lu LH, Choi WM, et al. Survival after a massive hydrofluoric acid ingestion with ECG changes. Am J Emerg Med. 2001;19(5):458-460. (Case report)

  85. Vohra R, Velez LI, Rivera W, et al. Recurrent life-threatening ventricular dysrhythmias associated with acute hydrofluoric acid ingestion: observations in one case and implications for mechanism of toxicity. Clin Toxicol (Phila). 2008;46(1):79-84. (Case report)

  86. Pelclova D, Navratil T. Do corticosteroids prevent oesophageal stricture after corrosive ingestion? Toxicol Rev. 2005;24(2):125-129. (Review; 572 patients)

  87. Massa N, Ludemann JP. Pediatric caustic ingestion and parental cocaine abuse. Int J Pediatr Otorhinolaryngol. 2004;68(12):1513-1517. (Case report)

  88. Gunnarsson M. Local corticosteroid treatment of caustic injuries of the esophagus. A preliminary report. Ann Otol Rhinol Laryngol. 1999;108(11 Pt 1):1088-1090. (Case report; 2 patients)

  89. Howell JM, Dalsey WC, Hartsell FW, et al. Steroids for the treatment of corrosive esophageal injury: a statistical analysis of past studies. Am J Emerg Med. 1992;10(5):421-425. (Review; 361 patients)

  90. Ulman I, Mutaf O. A critique of systemic steroids in the management of caustic esophageal burns in children. Eur J Pediatr Surg. 1998;8(2):71-74. (Retrospective; 246 patients)

  91. Boukthir S, Fetni I, Mrad SM, et al. High doses of steroids in the management of caustic esophageal burns in children. [French] Arch Pediatr. 2004;11(1):13-17. (Clinical trial; 26 patients)

  92. * Usta M, Erkan T, Cokugras FC, et al. High doses of methylprednisolone in the management of caustic esophageal burns. Pediatrics. 2014;133(6):E1518-E1524. (Randomized controlled trial; 83 patients)

  93. Chew LS, Lim HS, Wong CY, et al. Gastric stricture following zinc chloride ingestion. Singapore Med J. 1986;27(2):163-166. (Case report)

  94. Fang HY, Lin TS, Cheng CY. Pancreaticocolonic fistula after extensive corrosive injury from esophagus to jejunum. Zhonghua Yi Xue Za Zhi [Taipei]. 2000;63(1):77-81. (Case report)

  95. Filippini A, Pagliaricci L, Pomidori A. Reconstruction of the gastrointestinal tract in the absence of the oesophagus, stomach and colon, with preservation of the larynx. [Italian] Chir Ital. 2009;61(1):99-105. (Case report)

  96. Hawley CK, Harsch HH. Gastric outlet obstruction as a late complication of formaldehyde ingestion: a case report. Am J Gastroenterol. 1999;94(8):2289-2291. (Case report)

  97. Zhang X, Wang M, Han H, et al. Corrosive induced carcinoma of esophagus after 58 years. Ann Thorac Surg. 2012;94(6):2103-2105. (Case report)

  98. Seddik H, Ajana FZ, Benelbarhdadi I, et al. Caustic burn and cancer of the esophagus. [French]. Acta Endoscopica. 2001;31(5):713-716. (Case report)

Publication Information

Rachel S. Wightman, MD; Kevin B. Read, MLIS, MAS; Robert S. Hoffman, MD

Publication Date

May 1, 2016

CME Expiration Date

June 1, 2019

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