Corrosive Acid Injury

Ingestion of corrosive substances is common in India. In children, the ingestion injury is primarily due to accidental ingestion, but ingestion in adults is more often suicidal in intent and is frequently life-threatening too.

The ingested corrosive substances are either alkalis or acid. Alkaline material accounts for most caustic ingestions in Western countries whereas injuries from acid are more common in some developing countries, like India, where hydrochloric acid and sulphuric acid are easily accessible. Acids and alkalis produce different types of tissue damage. Acids cause coagulation necrosis, with scar formation that may limit substance penetration and injury depth conversely, alkalis combine with tissue proteins of body, and penetrate deeper into tissues.

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Symptoms

Diagnosis

Blood Test: may suggest infection or severity of damage (high white blood cell count (> 20000 cells/mm3), elevated serum C-reactive protein, an arterial pH less than 7.22)
CT scan: A CT scan of the chest and abdomen provides more detailed evaluation than early endoscopy about the transmural damage of esophageal and gastric walls and the extent of necrosis. It is more valuable than endoscopy in assessing threatened or established stomach perforation, and a CT grading system been proposed to predict esophageal stricture. With the advantage of not being invasive, CT scan has a promising role in the early evaluation of caustic injury damage.
Endoscopy: Endoscopy directly assesses the extent of damage and thus helps in planning the line of management but its avoided if there is suspicion of perforation or severe injury in mouth or in neck.

Treatment

Patient should immediately be transferred to hospital for further treatment. Homemade remedy like milk or water to neutralise the effect of ingested liquid has not be found effective. In the contrarily, pH neutralisation of acid by alkali fluid or vice versa may be dangerous as it produces the heat after reaction with each other and that may increase the damage. Milk and activated charcoal should be avoided because may obscure proper vision during subsequent endoscopy.
If patient is able to swallow own saliva without any discomfort, oral feeding may gradually be started. Otherwise, feeding is started by putting a tube in stomach under guidance of endoscopy or surgery is done to put a feeding tube in small –intestine.
Most of patients with minor injury, recovers well. Some patients may develop difficulty in swallowing (narrowing of esophagus) or early satiety (small size stomach) or vomiting (narrowing of outlet of stomach). Endoscopy or Barium study is done to look for any site of blockage. Most of time, endoscopic treatment is successful by regular dilation of narrowing and patient can swallow his/her meal. Surgery is advised if narrowing persists despite multiple attempts of dilatation.

Common Corrosive Agents

Caustic Agent	Type	Commercially Available Form
Acid	Sulfuric	Battery Industrial cleaning agent Metal plating
	Oxalic	Paint thinner, Stripper Metal cleaner
	Hydrochloric	Solvent Metal cleaner Toilet & drain cleaner Anti-rust compounds
Alkali	Phospharic	Toilet cleaner
	Sodium Hydroxide	Drain cleaner Home Soap manufacturing
	Sodium carbonate	Oven cleaner Washing powders
	Potasium Hydroxide	Oven cleaner Washing powders