Unfortunately, corrosive injuries in animals are relatively common and can be caused by a number of household items. Sources of these injuries can be acids, bases, phenols, aldehydes, alcohols, petroleum distillates, some salts of heavy metals, and cationic detergents such as dryer sheets.
Acids (corrosives) with a pH < 2 are commonly associated with corrosive injury, although acid swith a pH of < 3 can be corrosive. Alkalis (caustics) with pH of > 11.5 may cause injury, and those with a pH > 12.5 can cause perforation in as little as 1 second exposure time. With caustic agents, animals typically do NOT feel a “burn” in their mouth during ingestion resulting in more severe injury, in contrast to acids which are generally immediately painful. Phenols are corrosive at > 5%, and quaternary ammonium chlorides are corrosive at > 7.5% (but can see clinical signs in cats at as little as 1% as they are far more sensitive). Importantly, any amount of undiluted concentrated product is toxic!
Clinical signs can appear immediately or up to 24 hours post-exposure. Those include but are not limited to:
- GI: pawing at mouth, dysphagia, hypersalivation, anorexia, oral irritation or ulcers in mouth (may be grey, yellow, or black in color), vocalization, hematemesis, abdominal pain, peritonitis, septic peritonitis
- Severe burns can occur in the stomach- generally the pylorus is most severely affected.
- Respiratory: dyspnea, tachypnea secondary to aspiration, pneumonitis, esophageal perforation, pneumomediastinum, pneumothorax, pleuritis, etc.
- Dermatological: dermal irritation, inflammation, sloughing
- Systemic: pyrexia, dehydration, polydipsia, AKI, shock, collapse, death
If you suspect exposure to a corrosive material, DO NOT induce emesis or perform gastric lavage! Activated charcoal is NOT useful as it doesn’t bind corrosives – DO NOT administer or recommend. Decontamination guidelines are as follows:
- Oral exposure:
- Early dilution with water. If the pet does not drink, entice them by offering chicken broth, canned chicken noodle soup, water, milk, etc. With cats, offer them tuna juice (from tuna packed in water not oil), baby food, canned food grueled with water, chicken broth, etc.
- Owners can rinse the mouth at home if the animal is amenable, but only if done early and safely (less than an hour or so). They can also try to irrigate the mouth for 15-20 minutes at home. Warn the owner about risks of aspiration and do not use aggressive methods (e.g., tell them not to use a hose, etc., but rather the kitchen sink sprayer using a gentle stream and the head pointed downwards).
- Dermal exposure:
- Irrigate the area with copious amounts of tepid water for at least 15 minutes as soon as possible (ideally at home before leaving for the clinic). The use of neutralizing solutions (e.g., acid for an alkaline) should NOT be used, as it can cause a chemical thermal burn!
- Ophthalmic exposure:
- Flush eye with ophthalmic solution or water for 10-15 minutes as soon as possible (ideally at home before leaving for the clinic). Contact solution can be used but should not contain any soaps, chemicals, or other ingredients. DO NOT let pet rub eye or paw at eye.
Animals that are asymptomatic with only a small ingestion (e.g., taste, lick, etc.) can be monitored closely at home and instructed to seek care should any signs develop. Symptomatic animals, or those with exposures greater than a small taste or lick should be treated with supportive care:
- Further irrigate for 15-20 minutes with tepid water. Sedation and airway protection may be needed.
- Endoscopy: Any animal having ingested alkaline products, with oral irritation, should ideally have endoscopic exam. This should take place after 12-24 hours of supportive care. Endoscopy performed on a potentially damaged esophagus needs to be done CAREFULLY to avoid iatrogenic injury (e.g., perforation, pneumothorax, etc.).
- STOP AT THE FIRST SIGN OF NECROSIS!
- GI protectants: An anti-acid (ideally a PPI) plus sucralfate
- Diet: Soft food diet or NPO diet, depending upon extent of injury. An NG-tube, E-tube, or G-tube may be necessary for nutritional support. With severe esophageal injury, food and water should not be reintroduced without endoscopic evidence of healing.
- In dehydrated patients, crystalloids should be given IV or SQ.
- Antibiotics may be necessary, but use discretion.
- Analgesics: Opioids, NOT NSAIDs due to potential ulcers.
- Radiographs: Recommended to identify location of batteries and to rule out aspiration, pneumonitis, pneumomediastinum, pneumothorax (secondary to esophageal perforation), peritonitis, etc.
Prognosis varies based on exposure and clinical signs. For minor exposures, the prognosis good with supportive care. However, for any exposure resulting in esophageal perforation, the prognosis is grave. For these cases, aggressive care is necessary which may include surgical intervention. Esophageal strictures may occur weeks post-exposure, presenting as signs of regurgitation, dysphagia, etc.