Diagnostic Considerations
Airway obstruction may occur secondary to edema, bleeding, and the presence of necrotic material. Because this can develop rapidly, airway protection is paramount following caustic ingestions. Delays in securing a definitive airway can result in increased difficulty due to progressive airway edema.
Esophageal gastric, bowel, airway, or vascular perforation may occur.
Fluid losses from vomiting, third spacing, and gastrointestinal bleeding may lead to hypovolemia and shock. This is particularly true after ingestion of metallic chlorides.
After significant acidic ingestions, the patient may develop metabolic acidosis, hemolysis, and multiorgan failure including acute renal failure.
Hypocalcemia develops precipitously after ingestion of significant amounts of hydrogen fluoride.
In patients who survive the initial phases of injury, late-developing problems include the following:
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Strictures
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Fistula
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Hypomotility disorders
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Increased risk of gastrointestinal cancers
Differential Diagnoses
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Dysphagia
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Hemolysis
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Hydrofluoric acid
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Hypocalcemia
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Mercury chloride
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Munchausen Syndrome
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Pediatrics, Bronchiolitis
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Pediatrics, Gastrointestinal Bleeding
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Pediatrics, Pertussis
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Perforated Peptic Ulcer
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Phenol
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Renal failure
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Shock (many potential causes)
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Strictures, especially gastric
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Stridor
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Toxicity, Chlorine Gas
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Vomiting
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Zinc chloride
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Caustic ingestions. Endoscopic view of the esophagus in a patient who ingested hydrochloric acid (Lime-a-way). Note the extensive thrombosis of the esophageal submucosal vessels giving the appearance similar to chicken wire. Courtesy of Ferdinando L Mirarchi, DO, Fred P Harchelroad, Jr, MD, Sangeeta Gulati, MD, and George J Brodmerkel, Jr, MD.
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Caustic ingestions. Endoscopic view of the esophagus in a patient who ingested hydrochloric acid (Lime-a-way). Note the appearance of the thrombosed esophageal submucosal vessels giving the appearance of chicken wire. Courtesy of Ferdinando L Mirarchi, DO, Fred P Harchelroad, Jr, MD, Sangeeta Gulati, MD, and George J Brodmerkel, Jr, MD.
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Caustic ingestions. Endoscopic view of the esophagus in a patient who ingested hydrochloric acid (Lime-a-way). Note the extensive burn and thrombosis of the submucosal esophageal vessels, which gives the appearance of chicken wire. Courtesy of Ferdinando L Mirarchi, DO, Fred P Harchelroad, Jr, MD, Sangeeta Gulati, MD, and George J Brodmerkel, Jr, MD.
Tables
| Grade | Findings | Complication risk |
|---|---|---|
| 0 | None | None |
| 1 | Swelling and redness of mucosa | Low risk for development of outlet obstruction of strictures |
| 2A | Superficial ulcers, bleeding, friability | Low risk for development of outlet obstruction of strictures |
| 2B | Deep ulcers, bleeding, friability | High risk for strictures, low risk for perforation |
| 3A | Focal necrosis | High risk for strictures, moderate risk for perforation |
| 3B | Extensive necrosis | High risk for strictures and perforation, moderate risk for fatality |
| 4 | Perforation | High risk of fatality |
