Consultation with the Specialist
Corrosive Ingestions
Frederick H. Lovejoy Jr MD1
Alan D. Woolf MD, MPH2
1 William Berenberg Professor of Pediatrics
2 Associate Professor in Pediatrics, Harvard University School of Medicine, Children's Hospital, Boston, MA.
Two particularly relevant questions frequently asked by pediatricians about caustic ingestions by children are: 1) What signs and symptoms are common with a caustic ingestion, and can esophageal injury occur in the absence of mouth burns? and 2) When should the patient be referred to the surgeon for endoscopy to confirm a corrosive ingestion?
Signs and Symptoms
Approximately 53 000 corrosive exposures occur yearly in the United States. The Federal Hazardous Substances Act and the Poison Prevention Packaging Act of 1970 requires that corrosive agents that have concentrations of active ingredients greater than 10% be sold in child-resistant containers. This has done much to reduce the frequency and severity of signs and symptoms of corrosive ingestions. The child may lick or take only several swallows of a corrosive liquid compared with an adolescent purposefully ingesting a corrosive, who may consume a larger amount. The lips, oral mucosa, tongue, pharynx, esophagus, and stomach all may be affected. Other areas, such as the eyes, larynx, and/or respiratory tract, also may be exposed to the corrosive agent.
Many infants and children who have a history of ingesting a corrosive recently are without signs and symptoms. However, others have clear signs of injury, including pain on swallowing, drooling, excessive salivation, and inability or refusal to drink. Examination of the mouth shows edema, inflammation, or whitish areas.
