Corrosive / Caustic Injury — Acids vs. Alkalis

 

Substances & Common Names

• Acids (酸)
• Hydrochloric acid (鹽酸，除鏽劑、清潔劑)[1]
• Sulfuric acid (硫酸，汽車電池液) [2]
• Nitric acid (硝酸，肥料/工業)[3]
• Hydrofluoric acid (氫氟酸，玻璃蝕刻、金屬清潔)[4]
• Alkalis (鹼)
• Sodium hydroxide (氫氧化鈉/苛性鈉，水管疏通劑)[5].
• Potassium hydroxide (氫氧化鉀，烤箱清潔劑)[6].
• Calcium hydroxide (氫氧化鈣，石灰) [7].
• Ammonia (氨水，清潔劑/工業) [8].
• Sodium hypochlorite (次氯酸鈉，家用漂白水 3–6%) [9].

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Involving Systems

• 主要影響：GI tract、airway、eyes、skin [1], [5], [9]
• 酸 → coagulative necrosis，表層壞死較多，但也可穿孔 [1]
• 鹼 → liquefactive necrosis，深層滲透壞死 → 食管灼傷更嚴重 [10].

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Presentation

• 共同表現：
• 咽喉痛、流涎、吞嚥困難、嘔吐、胸/腹痛 [1]
• 嚴重 → 上消化道出血、穿孔、縱隔炎、呼吸困難 [1]
• 酸特徵 (尤其 HF)：
• 胃為主要損傷部位 [1]
• HF：低血鈣、心律不整、QT 延長 [4]
• 鹼特徵：
• 深入食管 → 高風險穿孔、狹窄 [6]
• 常見氣道水腫、聲音沙啞、呼吸窘迫 [6]

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Antidote

• 一般酸/鹼：無特效解毒劑[6]
• HF 特例：Calcium gluconate (IV 或 topical gel) [4]

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Disposition / Management [1, 4, 6]

• Immediate
• Airway first：出現聲音沙啞、喘鳴、流涎 → 早期插管
• 禁止催吐、洗胃、活性碳
• 可給予牛奶/水少量稀釋 (非強制)
• Evaluation
• 12–24 小時內胃鏡檢查 (避免 >48 小時)
• 影像檢查 (CT) 若懷疑穿孔
• Treatment
• Supportive care, IV fluids, pain control
• 類固醇：具爭議，可能降低食管狹窄，但感染風險 ↑
• 外科手術：穿孔、廣泛壞死時
• Long-term
• 食管狹窄 (最常見後遺症)
• 增加食管癌風險 (特別是鹼灼傷)

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References

• [1].Yu CH, Su YJ, Lai YC. Fatal Zargar grade 3b corrosive injury after hydrochloric acid ingestion: A case report. Medicine (Baltimore). 2024 Oct 4;103(40):e40017. doi: 10.1097/MD.0000000000040017. PMID: 39465708; PMCID: PMC11460919.
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• [2]. Mastrodicasa E. Sulfuric Acid Ingestion: May the Severity of the Metabolic Acidosis be Considered as a Predictive Sign of Late Damage to the Gastrointestinal Tract? Eur J Case Rep Intern Med. 2024 Apr 9;11(5):004437. doi: 10.12890/2024_004437. PMID: 38715891; PMCID: PMC11073603.
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• [3]. Colalillo JM, Skinner K. Why so blue? A novel presentation of methaemoglobinaemia secondary to an inhaled occupational nitric acid exposure. Clin Toxicol (Phila). 2025 Feb;63(2):145-147. doi: 10.1080/15563650.2024.2440547. Epub 2024 Dec 18. PMID: 39692141.
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• [4].Su YJ, Lu LH, Choi WM, Chang KS. Survival after a massive hydrofluoric acid ingestion with ECG changes. Am J Emerg Med. 2001 Sep;19(5):458-60. doi: 10.1053/ajem.2001.24503. Erratum in: Am J Emerg Med. 2009 Jan;27(1):126. PMID: 11555812.
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• [5].Barnes SS, Wong W Jr, Affeldt JC. A case of severe airbag related ocular alkali injury. Hawaii J Med Public Health. 2012 Aug;71(8):229-31. PMID: 22900239; PMCID: PMC3419824.
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• [6].Chibishev A, Pereska Z, Chibisheva V, Simonovska N. Corrosive poisonings in adults. Mater Sociomed. 2012;24(2):125-30. doi: 10.5455/msm.2012.24.125-130. PMID: 23678319; PMCID: PMC3633385.
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• [7].Schmidt SM, Schmidt CJ, Adler M, Rahmani B. Corneal injury due to a calcium hydroxide containing food preparation product ("cal"). Pediatr Emerg Care. 2008 Jul;24(7):468-70. doi: 10.1097/PEC.0b013e31817de2d3. PMID: 18633308.
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• [8].Czerwiec A, Chevallier C, Grenet G, Patat AM, de Souza S, Lichtfouse J; French Poison Centres Research Group; Boucher A, Paret N; List of French Poison Centres (Centre antipoison). Exposure to ammonia solution due to substance use: a retrospective study from the French poison centres database (2009-2018). Clin Toxicol (Phila). 2024 Feb;62(2):107-111. doi: 10.1080/15563650.2024.2313088. Epub 2024 Feb 28. PMID: 38416057.
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• [9].Patterson J, Vallance V. Severe chemical pneumonitis following exposure to household bleach. BMJ Case Rep. 2025 Mar 27;18(3):e262924. doi: 10.1136/bcr-2024-262924. PMID: 40147947.
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• [10].Boonekamp C, Voruz F, Fehlmann C. Accidental aspiration of a solid tablet of sodium hydroxide. BMJ Case Rep. 2018 Jun 21;2018:bcr2018224213. doi: 10.1136/bcr-2018-224213. Erratum in: BMJ Case Rep. 2018 Aug 17;2018:bcr-2018-224213corr1. doi: 10.1136/bcr-2018-224213corr1. PMID: 29930183; PMCID: PMC6020962.
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Edited by Yu-Jang Su       Aug 21, 2025

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