PEM Playbook – Caustic Ingestions
- Jan 29th, 2021
- Tim Horeczko
Originally published at Pediatric Emergency Playbook on October 1, 2020 – Visit to listen to accompanying podcast. Reposted with permission.
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Acids: low pH, coagulation necrosis, “what you see is what you get”, more respiratory damage, less perforation
- Battery acid, pool cleaners ⇒ very caustic
Alkali: saponification necrosis, deeper, increased risk for perforation, later stricture formation
- pH > 11 ⇒ increased risk of saponification necrosis
Decide: Plan A or Plan B?
Plan A: IV, resuscitate, NPO, monitor airway and signs of perforation, admit
Plan B: Observe for 4-6 hours, PO challenge, reassess, safety talk, close follow-up
- Symptoms of caustic ingestion ⇒ Plan A
- Drain Cleaner? Lye? pH of > 11? ⇒ Plan A
- Household bleach? pH <11 ⇒ Plan B; go to plan A if fails
- Unknown exposure, no symptoms? ⇒ Plan B; go to plan A if fails
Special Shout-Outs to:
Laundry Detergent Pods — although they have a pH of 9-11, the additive propylene glycol can cause CNS depression, seizures, further aspiration. Also, contact time (viscosity) is increased, leading to further alkali saponification
Drain cleaner — typical pH is 13-14. Full stop. Needs admission and scope in all cases.
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