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Acute poisoning with caustic substances: symptoms, diagnosis, treatment
Last reviewed: 07.07.2025
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In cases of poisoning with caustic substances (strong acids and alkalis), a chemical burn of the upper gastrointestinal tract develops, leading in some cases to perforation of the esophagus or stomach. Symptoms may include salivation, dysphagia, pain in the mouth, chest, abdomen; strictures may develop later. Endoscopic examination may be required for diagnosis. Treatment is supportive. Gastric lavage and administration of activated carbon are contraindicated. Perforations are treated surgically.
Typical sources of caustic substances are liquid and solid drain, water and toilet cleaners. Industrial products are usually more concentrated and therefore more dangerous in case of poisoning. Acids cause coagulative necrosis with the formation of a scab, which limits further damage. In acid poisoning, the stomach is damaged more than the esophagus. Alkalis cause rapid liquefactive necrosis without the formation of a scab, and damage occurs until the substance is neutralized or until its concentration decreases (due to dilution). Alkali poisoning most often leads to damage to the esophagus, but if a significant amount of the substance is ingested, severe damage to both the esophagus and stomach can occur.
Particles of solid toxic substances stick to and affect tissues, causing a local reaction, which limits further intake. Liquid toxic substances, on the contrary, can be taken in significant quantities, which leads to widespread (systemic) damage. In these cases, aspiration of the substance with damage to the upper respiratory tract is possible.
[ Symptoms of acute poisoning with caustic substances
Initial symptoms of acute poisoning with caustic substances are salivation and dysphagia. In severe cases, pain and sometimes bleeding from the mouth, throat, chest or abdomen are possible. Burns of the upper respiratory tract may cause coughing, tachypnea or stridor.
Examination of the oral cavity may reveal edematous, hyperemic tissues, but oral lesions are not typical of alkali burns, despite serious damage to the underlying gastrointestinal tract. Esophageal perforation may cause mediastinitis, the characteristic signs of which are intense chest pain, tachycardia, fever, tachypnea, and shock. Peritonitis may develop with gastric perforation. Esophageal and gastric perforation may occur within hours or weeks. Esophageal strictures may develop weeks later, even with mild primary symptoms and adequate treatment.
Since the presence or absence of oral burns does not allow one to reliably judge the damage to the esophagus and stomach, a thorough endoscopic examination is indicated to determine the presence and extent of esophageal and gastric burns if the anamnesis and physical examination data indicate poisoning with caustic substances.
Treatment of acute poisoning with caustic substances
Treatment of acute poisoning with caustic substances is supportive.
Warning: Gastric emptying by vomiting or lavage is contraindicated due to the possibility of repeated damage to the upper sections of the gastrointestinal tract by the caustic substance. Attempts to neutralize acids with alkalis (or vice versa) are contraindicated due to the possible development of severe exothermic reactions. Activated carbon, penetrating into damaged tissue, complicates endoscopic examination and assessment of the severity of damage, so its use is contraindicated.
Fluid intake is prescribed if tolerated. In case of esophageal or gastric perforation, antibiotics and surgical treatment are indicated. Preventive administration of intravenous antibiotics and glucocorticoids is not recommended. Strictures are treated with bougienage; if it is ineffective or the stricture is severe, colonoplasty of the esophagus is indicated.