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Acute poisoning with caustic substances: symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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When poisoning with caustic substances (strong acids and alkalis) develops a chemical burn of the upper gastrointestinal tract, leading in some cases to perforation of the esophagus or stomach. Symptoms may include salivation, dysphagia, pain in the mouth, chest, abdomen; later the development of strictures is possible. For diagnosis, endoscopy may be required. Treatment is supportive. Gastric lavage and the appointment of activated charcoal are contraindicated. Treatment of surgical perforations.
Typical sources of caustic substances are liquid and solid detergents for sewer pipes, water pipes and toilets. Industrial means, as a rule, are more concentrated and, as a consequence, more dangerous at poisoning. Acids cause coagulation necrosis with the formation of a scab that limits further damage. When poisoning with acids, the stomach is more affected than the esophagus. Alkalis cause rapid collisional necrosis without the formation of a scab, and damage occurs until the substance is neutralized, or until its concentration decreases (due to dilution). Poisoning with alkali often leads to damage to the esophagus, but when taking a significant amount of the substance, severe damage to both the esophagus and the stomach can occur.
Particles of solid poison agents adhere and affect tissues, causing a local reaction, which limits further admission. Liquid poison agents, on the contrary, can be taken in significant amounts, which leads to widespread (systemic) damage. In these cases, aspiration of the substance with upper respiratory tract infection is possible.
[Symptoms of acute poisoning with caustic substances
The initial symptoms of acute poisoning with caustic substances are salivation and dysphagia. In severe cases, pain and sometimes bleeding from the oral cavity, in the pharynx, thoracic or abdominal cavity. Burns of the upper respiratory tract can cause cough, tachypnea, or stridor.
When examining the mouth, you can see swollen, hyperemic tissues, but with alkali burns, oral damage is not characteristic, despite serious damage to the underlying gastrointestinal tract. Perforation of the esophagus can cause mediastenitis, the characteristic signs of which are intense pain in the chest, tachycardia, fever, tachypnea and shock. Perforation of the stomach can develop peritonitis. Perforation of the esophagus and stomach can occur within a few hours or weeks. Strictures of the esophagus can form in a week, even with a slight expression of primary symptoms and adequate treatment.
Since the presence or absence of oral burns does not allow one to reliably judge the lesion of the esophagus and stomach, a thorough endoscopic examination is performed to determine the presence and degree of burns of the esophagus and stomach, if the history and physical examination indicate poisoning with caustic substances.
Treatment of acute poisoning with caustic substances
Treatment of acute poisoning with caustic substances - supportive.
Caution: Emptying the stomach with vomiting or rinsing is contraindicated because of the possibility of repeated damage to the overlying gastrointestinal tract with caustic substance. Attempts to neutralize acids with alkalis (or vice versa) are contraindicated because of the possible development of severe exothermic reactions. Activated charcoal, penetrating into damaged tissues, complicates endoscopic examination and assessment of the severity of injuries, therefore its purpose is contraindicated.
Assign the drinking of liquids if it is portable. When perforating the esophagus or stomach, antibiotics and surgical treatment are indicated. The prophylactic administration of antibiotics and glucocorticoids is not recommended intravenously. Strictures are treated with bougie, with its ineffectiveness or severity stricture shows the performance of colonic plasty of the esophagus.