Caustic Exposures, Chemical Ingestions: Emergency Department Treatment
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Evidence-Based Management Of Caustic Exposures In The Emergency Department

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Table of Contents
Table of Contents
  1. Abstract
  2. Case Presentations
  3. Introduction
  4. Critical Appraisal of the Literature
  5. Etiology And Pathophysiology
  6. Differential Diagnosis
  7. Prehospital Care
  8. Emergency Department Evaluation
    1. History
    2. Physical Examination
    3. Predictors Of Injury
  9. Diagnostic Studies
    1. Laboratory Studies
    2. Imaging Studies
    3. Endoscopy
      1. Categorization Of Endoscopic Findings
      2. Limitations Of Endoscopy
  10. Treatment
  11. Special Populations And Considerations
    1. Laundry Detergent Pods
    2. Hydrofluoric Acid Exposure
      1. Treatment Of Hydrofluoric Acid Exposure
  12. Controversies And Cutting Edge
    1. Hâ‚‚ Blockers, Proton Pump Inhibitors, And Antibiotics
    2. Steroids
  13. Disposition
  14. Summary
  15. Risk Management Pitfalls For Managing Caustic Ingestions In The Emergency Department
  16. Time- And Cost-Effective Strategies
  17. Case Conclusions
  18. Clinical Pathway For Emergency Department Management Of Caustic Ingestion
  19. Clinical Pathway For Emergency Department Management Of Patients With Hydrofluoric Acid Exposure
  20. Tables and Figures
    1. Table 1. Common Caustics And Applications
    2. Table 2. Factors Affecting Caustic Toxicity
    3. Table 3. Approach To History-Taking In Patients With Caustic Ingestion
    4. Table 4. Caustics That Cause Systemic Toxicity
    5. Table 5. Endoscopic Grading Of Injury, Findings, And Prognosis
    6. Figure 1. Oropharyngeal Burns Secondary To Lye Ingestion
    7. Figure 2. Chest X-Ray With Evidence Of Perforation After Caustic Ingestion
    8. Figure 3. Endoscopic Findings Demonstrating Grade 2b Lesion After Ingestion Of Alkaline Caustic
  21. References
  22. References


Caustics are common in household and industrial products, and, when ingested, they can pose a significant public health risk. Caustic exposures in adults typically present in the setting of occupational exposure or suicide attempt; exposures in children occur most often by unintentional ingestion. Caustics cause local damage upon contact with tissue surfaces and can lead to systemic toxicity. Endoscopy is recommended in all intentional ingestions (and many unintentional ingestions) to grade injury severity, determine treatment options, and assess prognosis; however, it is generally best performed within 24 hours post ingestion to avoid risk of perforation. Radiography and computed tomography may also be used to visualize injury in certain cases. This review examines the pathophysiology of caustic exposures, their clinical presentations, and the most current evidence on recommendations for decontamination, surgical consult, treatment, and disposition.

Case Presentations

A 2-year-old girl presents to the ED with her parents, who state that they saw her drink a mouthful of toilet bowl cleaner that was in an unmarked container that had been left unattended. She cried and vomited immediately post ingestion. Upon presentation to the ED, she is still crying. Her vital signs are: heart rate, 164 beats/ min; blood pressure, 94/65 mm Hg; respiratory rate, 30 breaths/min; and oxygen saturation, 98% on room air. She is afebrile. Inspection of the skin and oropharynx is unremarkable, without ulcerations, lesions, or evidence of edema, and she is tolerating her secretions. Her lungs are clear to auscultation, and cardiac examination is significant only for tachycardia. Her abdominal examination demonstrates mild epigastric tenderness. You wonder about the best way to manage this patient: Does she need an IV? Laboratory tests? Imaging? Admission?

A 35-year-old man presents to the ED 2 hours after deliberate ingestion of a bottle of drain cleaner containing sodium hydroxide. He experienced chest pain and abdominal pain post ingestion and had 3 episodes of bloody emesis prior to arrival. In the ED, he appears uncomfortable. His vital signs are: heart rate, 120 beats/min; blood pressure, 120/80 mm Hg; respiratory rate, 25 breaths/ min; oxygen saturation, 98% on room air. He is afebrile. His physical examination is significant for abdominal pain with guarding and rebound as well as superficial ulceration of the oral mucosa. The nurse attaches the patient to the monitor and establishes IV access and then asks you, “Doctor, what should we do next?” (You think, "Good question.")


A caustic or corrosive is a xenobiotic that causes damage to tissue surfaces upon contact. Caustics are routinely found in household and industrial products as well as cosmetics and personal care items. According to the 2013 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System, 91% of all toxic exposures occur in the home.1 A list of common caustics and their uses is presented in Table 1.

Table 1. Common Caustics And Applications

Caustic exposures can occur via dermal, ocular, inhalation, and oral routes. Ingestion is the main cause of long-term morbidity and mortality. Injuries from caustic ingestion can range from mild gastrointestinal irritation and ulceration to life-threatening necrosis, perforation, and/or systemic toxicity.

Caustic ingestions follow a bimodal pattern, with peak occurrences in the pediatric population aged 1 to 5 years and then again later in adulthood.2 Eighty percent of reported caustic injuries occur in children, most often via unintentional exposure to household products, with the greatest incidence around 2 years of age.3,4 Adults may be exposed to household or industrial products as a result of an occupational accident or a suicide attempt.5 In children, 18% to 46% of all caustic ingestions are associated with esophageal burns. This percentage is likely higher in adults, who typically have more-severe injuries due to the greater volume of exposure when a caustic is consumed with suicidal intent versus unintentional ingestion.6,7

Caustic exposures have been a public health concern throughout history. Legislative changes, such as the mandating of child-resistant packaging and mandatory concentration reductions for household chemicals, in addition to public education campaigns for safer storage practices, have been employed to prevent poisonings. However, despite these efforts, caustic exposures still occur. In the United States, it is estimated that more than 200,000 exposures to household or industrial cleaning products and 5000 to 15,000 caustic ingestions occur annually.7-9

Fortunately, serious caustic exposures are uncommon events, but the emergency clinician must be able to recognize this potentially life-threatening entity and initiate proper therapies expediently. In this issue of Emergency Medicine Practice, we review basic pathophysiology and provide best-practice management recommendations for patients with caustic exposures.

Critical Appraisal Of The Literature

A literature search was completed using PubMed, which included MEDLINE®, Embase®, Web of Science, Cochrane Database of Systematic Reviews, Evidence-Based Medicine Reviews (EBMR), Database of Abstracts of Reviews and Effectiveness (DARE), and the National Guideline Clearinghouse databases. Studies were limited to meta-analyses, systematic reviews, clinical trials, and case reports/series. The search was separated into 3 separate concepts to include all keyword variations and achieve maximum sensitivity. The concepts included: (1) caustics, (2) ingestion, and (3) study type.

A total of 494 citations were found in MEDLINE®, 168 citations in Embase®, 76 citations in Web of Science, 0 citations in CDSR, DARE, and EBMR (searched together in 1 database), and 1 citation in the National Guidelines Clearinghouse, for a total of 739 citations. Foreign language articles with an abstract available in English were included, and those without an English-language abstract were excluded. The bibliographies of pertinent review articles and reference texts were reviewed to ensure important literature was not overlooked.

Risk Management Pitfalls For Managing Caustic Ingestions In The Emergency Department

  1. “My patient didn’t have any oral lesions after a caustic ingestion, so I didn’t think an endoscopy was indicated.” The presence or absence of oral findings on physical examination is not a reliable marker to predict the presence or absence of distal gastrointestinal tract injury.

  2. “My patient was asymptomatic after ingesting a caustic in a suicide attempt, so I admitted him to psychiatry without endoscopic evaluation.” All patients with intentional ingestion should have an endoscopy performed. Intentional ingestions generally cause more-severe injury than unintentional ingestions due to frequently greater ingested volume and concentration. Patients may also have co-ingestions or psychiatric issues that prevent the expression or realization of pain.

  3. “My patient came in complaining of severe pain to his hand after an HF exposure, but I didn’t see any skin changes, so I didn’t think there was a severe injury.” HF dermal exposures can cause significant pain and injury even without external physical examination findings. The onset may be delayed several hours.

  4. “The initial electrolytes and ECG in my patient with HF ingestion were normal, so I didn’t think further testing or monitoring was necessary.” In the setting of HF ingestion or large body-surface-area dermal burns, it is important to frequently assess electrolytes because the clinical condition can rapidly deteriorate and because these patients are at risk for dysrhythmia.

  5. “The patient came into the ED after caustic ingestion with tachypnea and stridor that rapidly progressed to respiratory failure. By the time the intubation medications were available and intubation was performed, he had significant airway edema. He had stable initial oxygen saturation, so I thought I had time to fully assess him prior to intubation.” Early airway intervention is key in patients with caustic exposure, and prophylactic airway management and/or intubation in patients with respiratory symptoms may need to be considered. Additionally, steroid therapy for caustic-induced airway edema should be considered.

  6. “A child came into the ED immediately after ingesting an LDP. She was asymptomatic, so I sent her home. Two hours after discharge, she developed respiratory distress.” Compared to children with traditional non-pod laundry detergent exposures, LDP exposures are associated with a significantly higher incidence of adverse health effects, including mental status changes and respiratory compromise.

  7. “The patient presented with difficulty swallowing 2 days post caustic ingestion. I thought it would be okay for the gastroenterologist to do an endoscopy to evaluate the extent of injury.” Endoscopy should be avoided on days 2 to 3 after a caustic injury due to increased risk of perforation.

  8. “My patient with caustic ingestion was discharged home and then was readmitted for repeated exposure in a suicide attempt.” In adults, the 2 most frequent causes of caustic ingestion are occupational exposure and intentional ingestion with the goal of self-harm. Thus, in adult exposures, it is important to ask whether the caustic was ingested in a suicide attempt. All patients with intentional ingestion should be admitted to the hospital for further evaluation, including endoscopy.

  9. “An 18-month-old came into the ED 1 hour after ingesting drain cleaner containing sulfuric acid. I gave her milk to try to neutralize the acid.” Any attempt at dilution of caustic ingestion should be limited to asymptomatic patients within minutes of ingestion. Attempts at neutralization can cause an exothermic reaction, worsening injury.

  10. “After helping a patient with HF exposure remove his clothing, the patient care tech in the ED picked the clothing up off the floor, without gloves, to place in a patient belongings bag. He later developed severe pain to both hands consistent with HF skin exposure.” Universal precautions and staff safety are of primary importance when caring for patients with caustic exposure. Staff education and procedural steps should be taken to ensure staff do not come into direct contact with these dangerous agents.

Tables and Figures

Table 1. Common Caustics And Applications


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)
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Publication Information

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

Publication Date

May 1, 2016

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