Exposure to caustic agents may occur via the dermal, ocular, respiratory, and gastrointestinal routes with the most significant of these, by far, resulting from ingestion.
Morbidity and mortality from exposures to caustics is a worldwide problem. One study from India describing outcomes in patients following acid ingestions found that acute complications occurred in 39.1% of cases with death resulting in 12.2%.131 In the United States, even though legislation limiting the concentration of caustic agents has existed since the early 20th century, exposures to both acids and alkalis continue to be significant. Data collected by the American Association of Poison Control Centers from 2002 through 2006 revealed 49,531 chemical acid exposures and 24,119 chemical alkali exposures. Of these, 7525 (15.2%) acid exposures and 4297 (17.8%) alkali exposures resulted in moderate to major outcomes and a total of 50 deaths occurred (see Chap. 135).
Caustics cause both histologic and clinical damage on contact with tissues. Table 104–1 lists common caustics and the commercial products that contain them. Many are available for home use, in both solid and liquid forms, with variations in viscosity, concentration, and pH.
Table 104–1. Sources of Common Caustics |Favorite Table|Download (.pdf)
Table 104–1. Sources of Common Caustics
|Acetic acid||Permanent wave neutralizers, photographic stop bath|
|Ammonia (ammonium hydroxide)||Toilet bowl cleaners, metal cleaners andpolishes, hair dyes and tints, antirust products, jewelry cleaners, floor strippers, glass cleaners, wax removers|
|Boric acid||Roach powders, water softeners, germicide|
|Formaldehyde, formic acid||Deodorizing tablets, plastic menders, fumigant, embalming agent|
|Hydrochloric acid (muriatic acid)||Metal and toilet bowl cleaners|
|Hydrofluoric acid||Antirust products, glass etching, microchip etching|
|Mercuric chloride (HgCl2)||Preservative|
|Methylethyl ketone peroxide||Industrial synthetic agent|
|Oxalic acid||Disinfectants, household bleach, metal polish, antirust products, furniture refinisher|
|Phenol (creosol, creosote)||Antiseptics, preservatives|
|Phosphoric acid||Toilet bowl cleaners|
|Phosphorus||Matches, fireworks, rodenticides, methamphetamine synthesis|
|Potassium permanganate||Illicit abortifacient, antiseptic solution|
|Selenious acid||Gun bluing agent|
|Sodium hydroxide||Detergents, paint removers, drain cleaners and openers, oven cleaners|
|Sodium borates, carbonates, phosphates, and silicates||Detergents, electric dishwasher preparations, water softeners|
|Sodium hypochlorite||Bleaches, cleansers|
|Sulfuric acid||Automobile batteries, drain cleaners|
|Zinc chloride||Soldering flux|
As early as 1927, regulatory legislation in the United States governing the packaging of lye- and acid-containing products mandated that warning labels be placed on products containing these xenobiotics. In response to the recognition that caustic exposures were more frequent in children, in 1970 the Federal Hazardous Substances Act and Poison Prevention Packaging Act were passed, stating that all caustics with a concentration greater than 10% must be placed in child-resistant containers. By 1973, the household concentration for child-resistant packaging was lowered to 2%. In addition, the subsequent development of poison prevention education dramatically decreased the incidence of unintentional caustic injuries in children in the United States. The positive impact of both regulatory legislation and education is ...