Corrosive poisoning results from ingestion, inhalation, or contact with strong acids or alkalis that cause chemical burns to tissues. Injury begins immediately after exposure and may progress for hours to days.

Common agents

Alkalis (more dangerous — cause deep liquefaction necrosis)

• Sodium hydroxide (drain/oven cleaners)

• Potassium hydroxide

• Ammonia solutions

• Dishwasher detergents

• Bleaches (sodium hypochlorite – moderate corrosive)

Acids (cause coagulation necrosis)

• Hydrochloric acid

• Sulfuric acid

• Nitric acid

• Toilet cleaners

• Battery acid

• Disinfectants

Alkalis typically damage the esophagus, while acids more often damage the stomach, but both can injure the entire aerodigestive tract.

2. Mechanism of Injury (Pathophysiology)

Alkali Injury

• Liquefaction necrosis

• Protein dissolution

• Deep tissue penetration

• High perforation risk

Acid Injury

• Coagulation necrosis

• Eschar formation

• More superficial but causes gastric perforation

Timeline of injury

3. Risk Factors

• Children accidental ingestion

• Storage in beverage containers

• Domestic workers & cleaners

• Industrial workers

• Suicide attempts

• Psychiatric illness

• Alcohol intoxication

4. Clinical Features

Symptoms depend on concentration and amount.

A. Oral & Upper Airway

• Burning mouth pain

• Drooling

• Difficulty swallowing (dysphagia)

• Painful swallowing (odynophagia)

• Hoarseness

• Stridor

• Oral ulcers

• White/black oral burns

Hoarseness = airway injury warning

B. Esophageal

• Severe retrosternal pain

• Dysphagia

• Vomiting

• Hematemesis

C. Gastric

• Epigastric pain

• Abdominal rigidity

• Perforation → peritonitis

D. Respiratory

• Cough

• Wheezing

• Respiratory distress

• Chemical pneumonitis

E. Systemic

• Shock

• Metabolic acidosis

• Sepsis (late)

5. Diagnostic Criteria

Suspect corrosive poisoning when:

• History of ingestion of cleaner/acid/alkali

• Drooling + dysphagia

• Oral burns

• Severe chest or abdominal pain

Absence of oral burns DOES NOT exclude severe injury

6. Investigations

Initial Tests

• Full blood count

• Urea, electrolytes, creatinine

• ABG (metabolic acidosis)

• Serum lactate

Imaging

• Chest X-ray → mediastinal air

• Abdominal X-ray → perforation

• CT scan → depth of necrosis (preferred)

Endoscopy (Key Investigation)

Perform within 12–24 hours

Contraindicated if:

• Perforation suspected

• Severe instability

Endoscopic grading (Zargar Classification)

7. Management

This is a medical emergency

8. Non-Pharmacological Treatment

Immediate Actions

• Remove contaminated clothing

• Rinse skin/eyes with water

• Keep patient nil per mouth (NPO)

Dilution Therapy

Give small volume water or milk within 30 minutes only

• Do NOT exceed small sips

Never attempt neutralization

Airway Management

• Oxygen therapy

• Early intubation if hoarseness/stridor

• Avoid blind nasogastric tube insertion

Surgical Review

Urgent surgical consultation for:

• Esophageal rupture

• Perforation

• Mediastinitis

• Peritonitis

Contraindicated

• Inducing vomiting

• Activated charcoal

• Neutralizing agents

• Gastric lavage

9. Pharmacological Treatment

Pain Control

• IV opioids (morphine titrated)

Acid Suppression

• IV proton pump inhibitor (omeprazole/pantoprazole)

Purpose:Reduce secondary injury and promote healing

Antibiotics

Only if:

• Perforation

• Fever

• Sepsis

• Grade IIb/III burns

Suggested:

• Ceftriaxone + metronidazole

Corticosteroids

Indicated in selected Grade II injuries

• Reduce stricture formation(Not recommended in perforation)

Nutrition

• Early enteral feeding via guided tube or jejunostomy if severe

10. Monitoring

Observe at least 48–72 hrs

Monitor:

• Respiratory status

• Signs of perforation

• Hemodynamic stability

• Ability to swallow

11. Complications

Early

• Airway obstruction

• Esophageal perforation

• Mediastinitis

• Peritonitis

• Shock

Late

• Esophageal stricture (weeks)

• Gastric outlet obstruction

• Chronic dysphagia

• Malnutrition

• Esophageal carcinoma (years later)

12. Prognosis

Depends on burn depth:

13. Prevention

Do’s

• Store chemicals locked

• Child-proof containers

• Keep original packaging

• Read labels carefully

Don’ts

• Never store in beverage bottles

• Never transfer to food containers

• Never leave containers open

• Never ingest unknown liquids