The emergency management of caustic ingestions.
Controversial therapeutic issues in patients with caustic ingestions concern the reliability of symptoms and signs in predicting esophageal injury, the appropriate use of endoscopy in evaluating esophageal damage, and the use of steroids in preventing late strictures. The conclusions of this review are: The majority of pediatric caustic ingestions involve a "lick and taste" whereas adolescents and adults often ingest substantial quantities. Oral burns and dysphagia are sensitive predictors of esophageal injury; however, esophageal injury may occur in the absence of the findings. Household bleach and nonphosphate detergents represent a low risk of injury whereas button batteries greater than 20 mm in diameter and Clinitest tablets represent high risk. Endoscopy should be an elective rather than emergency procedure and should be undertaken in all symptomatic patients, and in asymptomatic patients when history indicates substantial ingestion. Steroid therapy should be considered only for patients who have deep or circumferential esophageal burns.
D000143:Acids / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D000468:Alkalies / Q000506:poisoning; D000818:Animals; D002057:Burns, Chemical / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D002424:Caustics / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D002951:Citrates / Q000009:adverse effects; D019343:Citric Acid; D019327:Copper Sulfate; D003902:Detergents / Q000009:adverse effects; D004338:Drug Combinations / Q000009:adverse effects; D011211:Electric Power Supplies; D004724:Endoscopy; D004940:Esophageal Stenosis / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000517:prevention & control*; D004947:Esophagus / Q000473:pathology; D006795:Household Products / Q000009:adverse effects; D006801:Humans; D051379:Mice; D011859:Radiography; D017693:Sodium Bicarbonate; D012973:Sodium Hypochlorite / Q000009:adverse effects; D013256:Steroids / Q000627:therapeutic use
D000143:Acids; D000468:Alkalies; D002424:Caustics; D002951:Citrates; D003902:Detergents; D004338:Drug Combinations; D013256:Steroids; D019343:Citric Acid; C010892:Clinitest; D017693:Sodium Bicarbonate; D012973:Sodium Hypochlorite; D019327:Copper Sulfate