Test Your Knowledge: Alkali Exposure

Alkali caustic exposures can occur in the workplace with industrial chemicals, or in the home with common household products. These exposures, whether accidental or intentional, create risk for death or acute injury, such as airway compromise and esophageal or gastric perforation, as well as long-term complications such as stricture formation. Swift diagnosis and grading of these injuries will guide management options and are essential to reduce morbidity and mortality in these patients. 

Our recent issue Alkali Exposure: An Evidence-Based Approach to Diagnosis and Treatment reviews the evidence on emergency department management of alkali caustic exposures, with a focus on decontamination, resuscitation, and appropriate disposition.

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Here are a few key points:

• A caustic substance can be an acid or alkali; alkali caustics cause liquefactive necrosis, which allows deeper penetration and tissue damage.
• Household alkali caustics include detergents, degreasers, drain cleaners, and bleach, as well as hair straighteners, removers, and relaxers.
• Intentional ingestions are typically more severe, due to ingestion of larger quantities. Intentionality is classically used to risk-stratify patients for injury and subsequent management.
• A broad spectrum of injuries may occur from alkali exposures, depending on the type, volume, and concentration of the substance. See Table 1 in the issue.
• The extent of injury from an alkali exposure may take time to manifest.
• In managing a difficult airway of a patient with alkali ingestion, consider a multidisciplinary approach, involving ENT and/or anesthesia.

Read the full issue and earn 4 AMA PRA Category 1 Credits™.