Abstract
A 62-year-old man presented to the emergency department one week after accidentally drinking an alkaline cleaning agent stored in unlabeled bottle. The day of the incident the patient presented to an outside hospital where he was admitted for an upper endoscopy of the esophagus which was found to be negative for acute injury. An initial chest X-ray taken the day of the incident was also found to be normal. After discharge the patient continued to have a sore throat and marked dysphagia which caused him to vomit repeatedly. Moreover, the patient began to develop chest pain with associated shortness of breath. We present a case of delayed airway injury and tracheal thickening and associated chest pain after alkaline ingestion and we discuss herein the pathophysiology and management of alkaline ingestions.
Highlights
Alkaline ingestion is a concerning presentation for the emergency medicine physician
A key to alkaline injury is the fact that it causes liquefactive tissue necrosis leading to dissolution of cellular components and saponification of fatty tissues resulting in a liquid-gel amalgamation of dissolved cells and connective tissue
Because alkaline agents are not limited by decreased proteolysis or eschar formation, it is conceivable that tissue damage can continue after the initial insult due to infiltration of the alkaline material deep within the tissues
Summary
Alkaline ingestion is a concerning presentation for the emergency medicine physician. Ingestion of acidic media results in immediate denaturing of proteins which limits proteolysis of cellular constituents and leads to localized eschar formation which limits further tissue damage [3]. Because alkaline agents are not limited by decreased proteolysis or eschar formation, it is conceivable that tissue damage can continue after the initial insult due to infiltration of the alkaline material deep within the tissues. This case illustrates the importance of ensuring continue patient monitoring for caustic ingestions and minimizing subsequent untoward outcomes
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