Caustic injuries of the eye usually occur accidentally and can result in minor eye irritations to total loss of vision. All chemical exposures to the eye require immediate decontamination by copious irrigation with an aqueous
solution for at least 15-30 minutes up to two hours in single cases of massive exposure. Tap water is readily available, safe, and effective and, thus, the preferred irrigation fluid. Warmed
lactated Ringer's solution is theoretically preferable to
normal saline as an ocular irrigant because it has a more physiologic pH and osmolarity. Immediate ophthalmologic referral is recommended for all but the most trivial
chemical burns to the eye. Specific treatments for decontamination depend on the underlying agent.
Chemical burns of the skin usually occur accidentally. Initial treatment consists of copious water lavage commencing at the scene and removal of particles. While most
caustic injuries are treated symptomatically, exposures to
hydrofluoric acid (HFA) frequently necessitate specific topic, subcutaneous, intralesional, intravenous or
intraarterial injections of
calcium gluconate to bind
fluoride ions until
analgesia. A
burn from HFA that involves more than 5% of total body-surface area, or more than 1% of total body-surface area if the concentration of HFA is greater than 50%, requires admission to an ICU for electrocardiographic monitoring and serial measurements of
calcium levels, since life-threatening arrhythmias and
hypocalcemia can occur.
Caustic injuries of the gastrointestinal tract can occur due to inadvertent ingestion of mislabelled fluids or as a suicidal attempt. Ingestion of
alkalis is generally thought to result in more severe
injuries than ingestion of
acids. The oropharynx needs to be first examined by laryngoscopy. A supraglottic or epiglottic
burn with
erythema and
edema formation may be a harbinger of
airway obstruction and should be seen as an indication of early endotracheal intubation or
tracheostomy. Endoscopy should be performed preferably within 12 hours and generally not later than 24 hours and can serve as a prognostic tool to manage patients appropriately. The risk of procedure related perforation is generally accepted to be negligible. Existing data fail to support the routine use of
steroids and
antibiotics to prevent
esophageal stricture formation and may mask signs of
peritonitis. Esophageal
strictures,
stenosis or
gastric outlet obstruction are formidably long-term complications. There is a 1000- to 3000-fold increase in the incidence of esophageal
carcinoma after
lye-ingestion with a latent period between the time of ingestion and the development of
carcinoma as long as 60 years. Endoscopic dilatation or insertion of intraluminal
stents should not be performed within the first 6 weeks. Patients with grade 3b
injuries may underwent prompt surgical resection in single cases, even if no perforation is confirmed. Perforation, evolution of a
mediastinitis or
peritonitis with multi-organ failure are devastating complications with extremely high mortality and warrants immediate surgical treatment.