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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]