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Ingestion of a Caustic Substance in a Child

Essentials

  • Caustic substances include acids (60-80% vinegar, acid detergents, battery acid, fiberglass hardener) and alkali with a pH 12 (lye, dishwasher detergent, ammonia, sodium hydroxide).
  • Alkali with a pH > 12.5 and acids with a pH < 2 are especially caustic.
  • Washing the mouth and drinking fluid is an adequate first aid.
  • In general children without symptoms can be followed up at home, but those with symptoms should be referred to a hospital.

First aid at home

  • Wash the mouth and pharynx with water as soon as possible.
  • Give fluid (water, milk) to dilute the corrosive substance.
  • Do not induce vomiting.

First aid in primary care

  • Asymptomatic children can be sent home for follow-up. The parents are advised to contact the doctor if symptoms develop (see below).
  • Dysphagia (the child does not want to drink or eat), drooling, vomiting, or respiratory distress are indications for immediate referral to a hospital.
  • Also refer to a hospital all children who have ingested lye, an unknown corrosive substance, a detergent for dishwashing machines in institutional use (pH >12.5) or a strong acid (pH < 2).
  • Laboratory tests, radiographic examinations, corticosteroids Corticosteroids for Children Who have Ingested a Corrosive Substance 1 or antibiotics are not indicated.

Treatment in the hospital

  • If the child has dysphagia, drooling, vomiting, or respiratory distress, follow-up in a hospital or, if necessary, on an intensive care unit is indicated.
  • Haematemesis, difficulty breathing and simultaneous occurrence of more than 3 symptoms suggest a more serious corrosive lesion 2.
  • The child can take fluid and food freely if there is no vomiting or dysphagia preventing drinking and eating (in the latter case intravenous fluids should be administered).
  • No routine diagnostic investigations such as oesophagoscopy, laboratory tests or radiographs are indicated. Oesophagoscopy is performed no earlier than after 24-36 hours on children who have had salivation and pain on swallowing for 12-24 hours Assessment of Oesophageal Corrosion Injury in Children.
  • Endotracheal intubation may be indicated because of respiratory distress.

References

  • Pelclová D, Navrátil T. Pelclová D, Navrátil T. Do corticosteroids prevent oesophageal stricture after corrosive ingestion? Toxicol Rev 2005;24(2):125-9 [PubMed]
  • Lamireau T, Rebouissoux L, Denis D et al. Accidental caustic ingestion in children: is endoscopy always mandatory? J Pediatr Gastroenterol Nutr 2001;33(1):81-4. [PubMed]