Caustic burn: Difference between revisions
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==Background== | ==Background== | ||
{{Skin anatomy background images}} | |||
{{Caustics background}} | {{Caustics background}} | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:1215px-My hand with minor chemical burns.jpg|thumb|Hand with minor chemical burns exposure to commercial-grade dishwasher with concentrated chlorine.]] | |||
[[File:Sodium hydroxide burn.png|thumb|Chemical burn caused by sodium hydroxide solution (lye) 44 hours after exposure.]] | |||
[[File:Chemical burn CaCN2.png|thumb|Lower leg chemical burn caused by calcium cyanamide.]] | |||
[[File:Silbernitrat-Verätzung Collage.jpg|thumb|Water-thinned silver nitrate chemical burn on hand. Left: 7 hours after injury. Right: 26 hours after injury.]] | |||
[[File:Mustard gas burns.jpg|thumb|Caustic burn caused by exposure to [[mustard gas]] (World War I).]] | |||
[[File:HF burned hands.jpg|thumb|Hydrofluoric acid (HF) burns, which were not evident until a day after exposure.]] | |||
*Signs and symptoms are inadequate to predict presence or severity of injury after caustic ingestion <ref>Gaudreault, P. et al. Predictability of esophageal injury from signs and symptoms: a study of caustic ingestion in 378 children. Pediatrics. 1983;71(5):767-770.</ref> | |||
*Exam eyes and skin (splash and dribble injuries may easily be missed) | |||
*GI tract injury | |||
**[[Dysphagia]], odynophagia, [[epigastric pain]], [[vomiting]] | |||
*Laryngotracheal injury | |||
**[[Dysphonia]], [[stridor]], [[respiratory distress]] | |||
**Occurs via aspiration of caustic or vomitus or inhalation of acidic fumes | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Caustic burn types}} | {{Caustic burn types}} | ||
{{Burn DDX}} | |||
==Evaluation== | ==Evaluation== | ||
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*CBC | *CBC | ||
*Metabolic panel | *Metabolic panel | ||
*Lactate | *[[Lactate]] | ||
*Calcium level (if [[Hydrofluoric acid]] exposure) | *Calcium level (if [[Hydrofluoric acid]] exposure) | ||
*[[ECG]] | *[[ECG]] | ||
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==Management== | ==Management== | ||
First prevent personal exposure to the caustic agent by removing all clothing and decontaminating the patient | *First prevent personal exposure to the caustic agent by removing all clothing and decontaminating the patient | ||
*Brush any dry chemicals off the patient | |||
*Irrigate all wounds and areas of exposure with copious amounts of water | |||
**Exception: dry lime, phenol, metals such as potassium and sodium, causes harmful exothermic reaction | |||
===Acidic injuries (except [[Hydrofluoric acid]])=== | ===Acidic injuries (except [[Hydrofluoric acid]])=== | ||
May also have non | *May also have [[non anion gap acidosis]] (e.g. HCl) | ||
*Respond well to copious saline or water irrigation | *Respond well to copious saline or water irrigation | ||
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**Facial injuries | **Facial injuries | ||
**Perineum injuries | **Perineum injuries | ||
**Partial-thickness injuries >10-15% of BSA | **Partial-thickness injuries >10-15% of [[BSA]] | ||
**All full-thickness burns | **All full-thickness burns | ||
==See Also== | ==See Also== | ||
*[[Burns]] | *[[Burns]] | ||
*[[Caustic keratoconjunctivitis]] | |||
*[[Caustic ingestion]] | |||
==References== | ==References== | ||
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[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category:Toxicology]] | [[Category:Toxicology]] | ||
[[Category:Trauma]] | |||
[[Category:Symptoms]] | |||
Latest revision as of 16:18, 11 December 2024
Background
Caustics
- Substances that cause damage on contact with body surfaces
- Degree of injury determined by pH, concentration, volume, duration of contact
- Acidic agents cause coagulative necrosis
- Alkaline agents cause liquefactive necrosis (considered more damaging to most tissues)
- Corrosive agents have reducing, oxidising, denaturing or defatting potential
Alkalis
- Accepts protons → free hydroxide ion, which easily penetrates tissue → cellular destruction
- Liquefactive necrosis and protein disruption may allow for deep penetration into surrounding tissues
- Examples
- Sodium hydroxide (NaOH), potassium hydroxide (KOH)
- Lye present in drain cleaners, hair relaxers, grease remover
- Bleach (sodium hypochlorite) and Ammonia (NH3)
- Sodium hydroxide (NaOH), potassium hydroxide (KOH)
Acids
- Proton donor → free hydrogen ion → cell death via denatured protein → coagulation necrosis and eschar formation, which limits deeper involvement
- However, due to pylorospasm and pooling of acid, high-grade gastric injuries are common
- Mortality rate is higher compared to strong alkali ingestions
- However, due to pylorospasm and pooling of acid, high-grade gastric injuries are common
- Can be systemically absorbed and → metabolic acidosis, hemolysis, AKI
- Examples
- Hydrochloric acid (HCl), hydrofluoric acid (HF), Sulfuric acid (H2SO4), Phosphoric acid, Oxalic Acid, Acetic acid
- Found in: auto batteries, drain openers, toilet bowl, metal cleaners, swimming pool cleaners, rust remover, nail primer
- Hydrochloric acid (HCl), hydrofluoric acid (HF), Sulfuric acid (H2SO4), Phosphoric acid, Oxalic Acid, Acetic acid
Clinical Features
Caustic burn caused by exposure to mustard gas (World War I).
- Signs and symptoms are inadequate to predict presence or severity of injury after caustic ingestion [3]
- Exam eyes and skin (splash and dribble injuries may easily be missed)
- GI tract injury
- Dysphagia, odynophagia, epigastric pain, vomiting
- Laryngotracheal injury
- Dysphonia, stridor, respiratory distress
- Occurs via aspiration of caustic or vomitus or inhalation of acidic fumes
Differential Diagnosis
Caustic Burns
- Caustic ingestion
- Caustic eye exposure (Caustic keratoconjunctivitis)
- Caustic dermal burn
- Airbag-related burns
- Hydrofluoric acid
- Tar burn
- Cement burn
Burns
- Smoke inhalation injury (airway compromise)
- Chemical injury
- Acrolein
- Hydrochloric acid
- Tuolene diisocyanate
- Nitrogen dioxide
- Systemic chemical injury
- Specific types of burns
- Associated toxicities
Evaluation
- Clinical diagnosis
Work-up
Only necessary in patients with significant injury or volume of ingestion
Consider:
- CBC
- Metabolic panel
- Lactate
- Calcium level (if Hydrofluoric acid exposure)
- ECG
- May show QT-prolongation if hypocalcemic secondary to Hydrofluoric acid
- APAP/ASA levels if concerned about coingestion (suicidal patients)
Management
- First prevent personal exposure to the caustic agent by removing all clothing and decontaminating the patient
- Brush any dry chemicals off the patient
- Irrigate all wounds and areas of exposure with copious amounts of water
- Exception: dry lime, phenol, metals such as potassium and sodium, causes harmful exothermic reaction
Acidic injuries (except Hydrofluoric acid)
- May also have non anion gap acidosis (e.g. HCl)
- Respond well to copious saline or water irrigation
Alkali injuries
- May appear superficial but often are deeper with ongoing burn
- Treat with copious irrigation and local wound debridement to remove residual compound
Disposition
- Admit the following:
- Injuries that cross flexor or extensor surfaces
- Facial injuries
- Perineum injuries
- Partial-thickness injuries >10-15% of BSA
- All full-thickness burns
See Also
References
- ↑ Wasserman RL, Ginsburg CM. Caustic substance injuries. J Pediatr. 1985;107(2):169-174. doi:10.1016/s0022-3476(85)80119-0
- ↑ Harley EH, Collins MD. Liquid household bleach ingestion in children: a retrospective review. Laryngoscope. 1997;107(1):122-125. doi:10.1097/00005537-199701000-00023
- ↑ Gaudreault, P. et al. Predictability of esophageal injury from signs and symptoms: a study of caustic ingestion in 378 children. Pediatrics. 1983;71(5):767-770.