Corrosive substances ingestion: a review

Figures & data

Table 1. Summary of fatal corrosive ingestions (2012–2017 AAPCC NPDS Data) (Mowry et al. 2013, 2014, 2015, 2016; Gummin et al. 2017, 2018).

Chemical substance	Age/gender	Reason (intentional/ unintentional/ unknown)
Sulfuric Acid	94 y.o. Male	Intentional (Suicide)
Ammonium Hydroxide	30 y.o. Female	Intentional (Suicide)
Alkali Drain Cleaner	50 y.o. Male	Intentional (Suicide)
Hypochlorite Cleaner	56 y.o. Female	Unknown
Alkali Drain Cleaner	58 y.o. Male	Intentional (Suicide)
Alkali Toilet Bowl	65 y.o. Female	Intentional (Suicide)
Cleaner
Alkali Laundry Detergent	85 y.o. Male	Unintentional
Alkali Drain Cleaner	85 y.o. Male	Unintentional
Alkali Liquid Laundry	87 y.o. Female	Unintentional
Detergent
Acid Drain Cleaner	97 y.o. Male	Unintentional
Hydrochloric Acid	36 y.o. Male	Intentional (Suicide)
Drain Cleaner (Sulfuric Acid)	52 y.o. Male	Intentional (Suicide)
Hypochlorite	63 y.o. Male	Intentional (Suicide)
Alkali Drain Cleaner	71 y.o. Female	Unintentional
Alkali Drain Cleaner	81 y.o. Female	Unintentional
Alkali Drain Cleaner	86 y.o. Male	Intentional (Suicide)
Hypochlorite	87 y.o. Female	Unintentional
Laundry Detergent (pod)	7 m.o. Male	Unintentional
Hydrochloric Acid	25 y.o. Male	Intentional (Suicide)
“Acid” (Not Otherwise Specified)	77 y.o. Male	Intentional (Suicide)
Hydrochloric Acid	82 y.o. Male	Intentional (Suicide)
Sulfuric Acid	>/=20 y.o. Female	Unknown
Hypochlorite	23 y.o. Female	Intentional (Suicide)
Acid Toilet Bowl Cleaner
Alkali Drain Cleaner	25 y.o. Male	Intentional (Suicide)
Hypochlorite	35 y.o. Female	Intentional (Suicide)
Laundry Detergent Pod	43 y.o. Female	Unintentional
Hypochlorite	47 y.o. Female	Intentional (Suicide)
Acid Toilet Bowl Cleaner	49 y.o. Male	Intentional (Suicide)
Alkali Drain Cleaner	61 y.o. Female	Intentional (Suicide)
Phenol Disinfectant	65 y.o. Female	Unknown
Laundry Detergent Pod	67 y.o. Male	Unintentional
Laundry Detergent Pod	72 y.o. Male	Unintentional
Alkali Drain Cleaner	80 y.o. Male	Intentional (Suicide)
Anionic/Nonionic Cleaner	82 y.o. Male	Intentional (Suicide)
Acid Toilet Bowl Cleaner	90 y.o. Male	Intentional (Suicide)
Laundry Detergent Pod	100 y.o. Female	Unintentional
Anionic/Nonionic Cleaner	80+ y.o. Female	Unintentional
Industrial Cationic Cleaner	71 y.o. Female	Unintentional
Hydrochloric Acid	63 y.o. Male	Intentional (Suicide)
Hydrochloric Acid	64 y.o. Female	Intentional (Suicide)
Alkali Drain Cleaner	22 y.o. Male	Intentional (Suicide)
Acid Toilet Bowl Cleaner	53 y.o. Male	Intentional (Suicide)
Hypochlorite	54 y.o. Male	Intentional (Suicide)
Hypochlorite	59 y.o. Male	Intentional (Suicide)
Sulfuric Acid	60 y.o. Female	Intentional (Suicide)
Liquid Laundry Detergent	74 y.o. Male	Unintentional
Alkali Drain Cleaner	75 y.o. Female	Intentional (Suicide)
Laundry Detergent Pod	81 y.o. Female	Unintentional
Laundry Additives	88 y.o. Female	Unintentional
Acid Toilet Bowl Cleaner	93 y.o. Female	Unintentional
Ammonia	80 y.o. Male	Intentional (Suicide)
Hydrochloric Acid	92 y.o. Female	Intentional (Suicide)
Drain Cleaner (Alkali)	42 y.o. Female	Intentional (Suicide)
Sodium Hypochlorite	45 y.o. Male	Intentional (Suicide)
Household Cleaner	57 y.o. Female	Intentional (Suicide)
Cleaner (Anionic/Nonionic)	58 y.o. Female	Unintentional
Acid Toilet Bowl Cleaner	50 y.o. Female	Intentional (Suicide)
Toilet BowlCleaner (Alkali)	60 y.o. Female	Intentional (Suicide)
Drain Cleaner (Hydrochloric Acid)	64 y.o. Female	Intentional (Suicide)
Drain Cleaner (Alkali)	66 y.o. Female	Intentional (Suicide)
Drain Cleaner (Alkali)	66 y.o. Male	Intentional (Suicide)
Hypochlorite Drain Cleaner (Alkali)	73 y.o. Female	Unintentional
Drain Cleaner (Alkali)	78 y.o. Female	Unintentional
Sodium Hydroxide	81 y.o. Female	Unintentional
Phosphoric Acid	87 y.o. Female	Intentional (Suicide)
Drain Cleaner (Alkali)	89 y.o. Male	Unintentonal
Caustic	82 y.o. Male	Unintentional
Sodium Hydroxide	73 y.o. Female	Unintentional
SodiumHydroxide	73 y.o. Female	Unintentional
Cleaner (Acid)	87 y.o. Male	Unintentional
Hydrochloric Acid	58 y.o. Male	Intentional (Suicide)
Oxalic Acid	67 y.o. Female	Intentional (Suicide)
Hydrochloric Acid	68 y.o. Female	Intentional (Suicide)
Hydrochloric Acid	73 y.o. Male	Intentional (Suicide)
Sodium Hydroxide	89 y.o. Female	Unintentional
Drain Cleaner (Sodium Hydroxide/ Sodium Hypochlorite/ Sodium Silicate)	46 y.o. Female	Intentional (Suicide)
Cleaner (Cationic)	50 y.o. Male	Unintentional
Drain Cleaner	50 y.o. Male	Intentional (Suicide)
Drain Cleaner	58 y.o. Male	Intentional (Suicide)
Drain Cleaner (SulfuricAcid)	59 y.o. Female	Intentional (Suicide)
Drain Cleaner (Alkali)	65 y.o. Female	Itentional (Suicide)
Cleaner (Anionic/ Nonionic/Hypochlorite)	67 y.o. Female	Unintentional
Hypochlorite	69 y.o. Male	Unintentional
Drain Cleaner (Sodium Hydroxide/ Hypochlorite/ Sodium Hypochlorite/ Sodium Silicate)	71 y.o. Female	Intentional (Suicide
Hypochlorite	72 y.o. Female	Intentional (Suicide)
Laundry Detergent (Pods)	77 y.o. Male	Unintentional
Drain Cleaner (Aluminum Dust/ Sodium Chloride/ Sodium Hydroxide/Sodium Nitrate)	78 y.o. Female	Unintentional
Drain Cleaner (Sodium Hydroxide/ Sodium Hypochlorite/ Sodium Silicate)	82 y.o. Male	Intentional (Suicide)
Cleaner (Cationic)	89 y.o. Female	Unintentional
Drain Cleaner (Sulfuric Acid)	91 y.o. Female	Unintentional
Laundry Detergent	93y.o. Male	Unintentional
Anionic/Nonionic/Citric Acid/ Oxone/Sodium Carbonate/ Sodium Percarbonate/ Soddium Sulfate)	74 y.o. Female	Adverse Reaction (Other)

Table 2. Classification of mucosal injury (adapted from Zargar et al. 1991).

Classification	Description of lesions
0	Normal examination
1	Mucosal edema and hyperemia
2a	Whitish appearing mucosal membranes, superficial ulcerations, mucosal erosions, friability, blister formation, exudates, hemorrhages
2b	All of 2a above plus deep discrete or circumferential ulcerations
3a	Multiple ulcerations in small scattered areas and areas of necrosis with a brownish- black or grayish discoloration
3b	Extensive necrosis

Table 3. Classification of mucosal injury (adapted from Kikendall 1991).

Classification	Description of lesions
I	Edema and erythema
IIA	Hemorrhage, erosions, superficial ulcerations
IIB	Circumferential lesions
III	Deep gray brown/black ulcers
IV	Perforation

Figure 1. (a) Sodium hydroxide (caustic soda; Destop®) ingestion. Additional skin exposure on face, neck, and right arm. 4-½ hours post-ingestion. (b and c) 8 d post-ingestion. The facial and oral lesions are completely healed.

Figure 2. (a) Caustic soda (sodium hydroxide) ingestion. Lips and tongue injuries. (b) At emergent surgery, necrosis of the anterior stomach wall with perforations. (c) At emergent surgery, duodenal edema and injury of segment II of the liver.

Table 4. The DROOL score (adapted from Uygun et al. 2012).

Signs/symptoms (acronym)	Score 0	Score 1	Score 2
(D) Drooling saliva	>/=12 h	<12 h	None
(R) Reluctance to eat; Food intolerance	>/=24 h	<24 h	None
(O) Oral or Oropharyngeal Tissue lesions	Severe Lesions (Friability, hemorrhage, erosions, blister formation, whitish discolored mucous membranes, exudates, ulcer(s) or necrosis)	Edema or hyperemia	None
(O) Any Number of Other Signs/Symptoms	Persistent elevated temperature, hematemesis, abdominal tenderness, retrosternal pain, dyspnea (>/=2)	1	None
(L) Leukocytosis	Elevated white blood cell count (>/=20,000)	<20,000	None

Table

Age (in 10-year intervals)	1
Corrosive substance type
Strong acid	2
Other corrosive substances	0
Admission white blood count
<20,000/mm^3	0
>20,000/mm^3	2
GI tract injury
Grade 0 or 1	0
Grade 2	2.5
Grade 3	3

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