S15C194 - Caustics

Question 1

Examples of Acidic caustic compounds

Answer 1

• sulfuric acid (battery, fertilizer)
• acetic acid (prinintg, hair perm)
• hydrochloric acid (meatal cleaner, swimming pool cleaner)
• hydrofluoric acid (rust remover)
• formic acid
• nitric acid

Question 2

Examples of Alkali products

Answer 2

• sodium hydroxide (oven cleaner)
• potassium hydroxide (battery)
• calcium hydroxide (cement)
• ammonium hydroxide (perm, toilet cleaner)
• lithium hydroxide (battery)
• soidum tripolyphosphate (detergents)
• sodium hypochlorite (bleach)

Question 3

Household bleach is minimally caustic

Answer 3

true

• produces only mild burns
• industrial bleach causes esophageal necrosis and gastric

Question 4

Acids and bleeding

Answer 4

-produce a coagulation necrosis

Question 5

Hydrofluoric exposure

Answer 5

-source: rust remover, petroleum industry, glass and microchip etching, jewelry cleaners

• QT prolongation from hypocalcemia
• free fluoride ion complexes with calcium and magnesum resulting in calcium chelation and cellular death
• most burns occur on upper extremities, resulting in pain and erythema, may have POOP, wounds have white discolouration then become black and necrotic
• hypocalcemia, hypomagnesemia and hyperkalemia and acidosis result in ventricular dysrhythmias (VF)
• tx: irrigation, gel paste of calcium gluconate for pain or intradermal injxn, or IV Calcium gluconate through arterial line proximal to injury
• if ingested give 10% calcium gluconate 300cc PO

Question 6

Caustic toxicity

Answer 6

• ABC - airway
• consider dex for airway edema
• D - charcoal contraindicated
• endoscopy

Question 7

Ocular exposure

Answer 7

• immediate irrigation for at least 15 mins
• use nitrazine or litmus paper to assess inital ocular pH and to guide irrigation
• normal pH should be 7.4, after irrigation pH should be b/w 7.5-8
• wait a few mins after irrigation before checkin pH, rpt irrigation with 15 min cycles until desired pH has been reached
• if corneal haziness, opacity, limbal ischemia present refer to ophtho emergently, otherwise f/u with oph in 24h

Question 8

Disc batteries

Answer 8

• remove if in esophagus or trachea

- if in stomach, re-xray in 24h to ensure it has passed, monitor stools