Pop Quiz #3

A child is crying and holding an open bottle

of Red Devil Drain Cleaner. Which of the
following statements are true?
A.

Since the active ingredient, sodium

hydroxide, is a base, vinegar, a weak
acid, should be administered to
neutralize.
B. It should be assumed that this child has
ingested a non-toxic dose and no
treatment is needed.
C. It should be assumed that if it was a very
brief duration of contact to the throat, it
is a minor irritant.
D. Activated charcoal and syrup of ipecac
are contraindicated.

Common Caustic Household Agents

o Acid
toilet bowl cleaners, some drain openers,
automobile battery fluid; muriatic acid (HCl for
swimming pool); hydrofluoric acid for wire/spoke
cleaners and rust removers

o Alkali
drain openers, oven cleaners, automatic
dishwasher detergents, household ammonia
(ammonium hydroxide), Clinitest reagent tablets

C a u s t i c A g e n t s - M e c h a n i s m o f Tox i c i t y

o Alkali: Liquefaction necrosis

o Acid: Coagulation necrosis
o Others: Alkylation, oxidation, reduction,
denaturing of proteins, defatting surface
tissues

Fa c t o r s A f f e c t i n g B u r n S e ve r i t y

o Quantity
o Concentration
o Duration of contact

Fa c t o r s A f f e c t i n g B u r n S e ve r i t y ( c o n t d )

o Physical form (e.g. powder versus liquid)

o pH
o Dissociation, ability to donate H+ or OHo Ability of counter ion to penetrate biological
membrane
o Exothermic reactions

Clinical Presentation of Caustic Agents

o Ingestion

Oral pain, burning, blister

Dysphagia
Drooling
Chest/abdominal pain
Vomiting
Tissue scarring, stricture
Acidosis (acid ingestion)

C l i n i c a l P r e s e n t a t i o n ( c o n t d )

o Dermal & Ocular:

Injury may range from mild irritation to full
thickness burns.

Tr e a t m e n t f o r C a u s t i c A g e n t s

o Ingestion:

Dilution OK if patient able to tolerate

Avoid neutralization
Emesis contraindicated
Activated charcoal generally not recommended
Consider lavage in large ingestions
- use soft, flexible nasogastric tube

Endoscopy
Surgery if indicated

Tr e a t m e n t f o r C a u s t i c A g e n t s ( c o n t d )

o Dermal & Ocular:

Copious irrigation
Subsequent treatment as for equivalent thermal
burn

Tr e n d s i n D e c o n t a m i n a t i o n :
C h i l d r e n < 6 ye a r s o l d
14
12
Exposures, %

10
8

Charcoal

Ipecac

4
2
0

1985

1995

2007

A A P Po l i c y S t a t e m e n t :
Po i s o n Tr e a t m e n t i n t h e H o m e

o Ipecac should no longer be used

o Ipecac should be safely disposed
o Safety & Efficacy of Charcoal not established
Pediatrics 112(5):1182-1184 (2003)

Pop Quiz #2
A mother calls after her 2 year old girl was found
with an empty bottle of Tylenol. Which of the
following statements are true? None of these are
correct need to call the poison center.
A.
B.
C.
D.

The active ingredient, acetaminophen, is the

major cause of poisoning deaths in children.
It should be assumed that this child has
ingested a non-toxic dose and no treatment is
needed.
It should be assumed that this child has
ingested a toxic dose and be sent to the
hospital.
It should be assumed that this child has
ingested a toxic dose and given syrup of
ipecac.

A c t iva t e d C h a r c o a l

o Agent of choice: Suspension without sorbitol

o Dose: 1 gram/kg (exceed dose of toxin by ratio
of 10:1)
o Contraindications / problems:
Caustic ingestions, ileus, bowel obstruction
Adsorbs other PO meds., aspiration potential

A c t iva t e d C h a r c o a l ( c o n t d )

o Binds high molecular weight, non-ionized,

water-soluble compounds.
o Examples of substances not effectively bound:
Caustics (Lye), petroleum distillates
Elemental metals (iron, lithium)
Ethanol & other alcohols

Pop Quiz #3
A child is crying and holding an open bottle
of Red Devil Drain Cleaner. Which of the
following statements are true?
A.

Since the active ingredient, sodium

hydroxide, is a base, vinegar, a weak
acid, should be administered to
neutralize.
B. It should be assumed that this child has
ingested a non-toxic dose and no
treatment is needed.
C. It should be assumed that if it was a very
brief duration of contact to the throat, it
is a minor irritant.
D. Activated charcoal and syrup of ipecac
are contraindicated.

Take Home Assignment

o Which of the following products has the potential
for life-threatening toxicity if a mouthful was
ingested by a 18 month old child?

Hearing Aid Battery (one battery ingested)

Petroleum jelly
Hydrogen peroxide 3%
Lemon scented furniture polish
Bleach (3% hypochlorite)
Beer (4% ethanol)
Rust remover with 6% HF