PEDBASE.org - The Pediatric Database - Detailed information of ACID/ALKALI INGESTION

ACID/ALKALI INGESTION

DEFINITION:

An acute ingestion of acidic or alkaline agents.

EPIDEMIOLOGY:

incidence: ?
age of onset:
- any
risk factors:
- suicidal ideation

PATHOGENESIS:

1. Alkaline Agents

1. Sources

crystalline drain or oven cleaners, bleach, automatic dishwater detergents, disc batteries

2. Burn Type

tend to produce liquefaction necrosis where a strong base binds to fat and oil in the tissue producing a soap
may produce streak-like or circumferential burns; the latter may produce esophageal stricture and occlusion
batteries may produce localized areas of burn +/- perforation

2. Acidic Agents

1. Sources

sulfuric, nitric, or hydrochloric acids

2. Burn Type

tend to concentrate at the pylorus producing scarification
+/- stricture formation
may burn other areas as well, i.e., esophagus, stomach

CLINICAL FEATURES:

1. Gastrointestinal Manifestations

dysphagia, drooling, vomiting
burns on lips, mouth, tongue, pharynx

2. Complications

esophageal or gastric perforation
respiratory distress due to:
- pneumomediastinum with chest or back pain, dyspnea
- laryngeal involvement with hoarseness, stridor, dyspnea
shock

INVESTIGATIONS:

not indicated in the acute setting

MANAGEMENT:

I. INITIAL MANAGEMENT

A. Airway

contact ENT stat

B. Breathing

C. Circulation

start IV in case of esophageal involvement
NPO after milk or water given

E. Eliminate

for acid or alkali ingestion
- milk or water
  - 250-500 cc (age 1-5 years)
  - up to 1000 cc (age >5 years)
for bleach ingestion give water then milk
syrup of ipecac, gastric lavage, activated charcoal, and cathartics are contraindicated

II. MAINTENANCE THERAPY

1. Endoscopy

perform at 1-6 days post ingestion to rule out burns
perform at 2-3 weeks post ingestion to rule out esophageal stricture

2. Prognosis

esophageal stricture develop in 15% of cases

Pediatric Database - ACID/ALKALI INGESTION

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