Caustic burns

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  • 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


  • 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), ammonia (NH3)
    • Found in: bleach, drain openers, oven cleaners, toilet cleaner, hair relaxers


  • Proton donor → free hydrogen ion → cell death 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
  • Can be systemically absorbed and → metabolic acidosis, hemolysis, AKI
  • Examples
    • Hydrochloric acid (HCl), hydrofluoric acid (HF), Sulfuric acid (H2SO4)
    • Found in: auto batteries, drain openers, metal cleaners, swimming pool products, rust remover, nail primer

Clinical Features

  • Signs and symptoms are inadequate to predict presence or severity of injury after caustic ingestion [1]
  • 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


  • Clinical diagnosis


Only necessary in patients with significant injury or volume of ingestion


  • 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)


  • 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


  • 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


  1. 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.