27 - Corresives

Abstract

Corrosives (or caustics) are strong alkalis and/or acids, which cause tissue destruction. Acids produce a coagulation necrosis that tends to cause a superficial type of damage rather than a deep, penetrating type of burn. Alkalis tend to cause a deep and penetrating necrosis, which often results in severe effects such as esophageal perforation. This chapter discusses the effects, clinical features, and management of toxicities caused by corrosives. Most toxic-related emergencies due to corrosives result from accidental exposure to household products such as toilet bowl cleansers and metal cleaners. Although acid ingestions are less common than alkali ingestions, morbidity and mortality (18%) are worse for acid ingestions. Exposure to corrosives may result in severe burns depending on the determinants of toxicity, such as the type of substance ingested, pH, volume ingested, concentration, contact time, volume of liquid material in stomach, toxicity for the pyloric sphincter, and exothermic reactions (alkali). The severity and extent of damage to the gastro-intestinal tract produced by corrosive substances depend on the morphological form of the caustic agent. In the acute stage, perforation and necrosis may occur. Lesions caused by ingestion of corrosive substances have so far been treated at the time of sequelae. The first step of the treatment is fasting, fluid replacement, and analgesics if required. Corrosive strictures of the esophagus are common, and being long and dense they frequently require surgical replacement of the esophagus.