What is the management for accidental ingestion of wood hardener?

Management of Accidental Wood Hardener Ingestion

Immediate contact with Poison Control Center (800-222-1222) is essential for managing accidental wood hardener ingestion, followed by prompt medical evaluation and supportive care based on the corrosive properties of the substance. 1

Initial Assessment and Stabilization

• Identify the specific wood hardener product, quantity ingested, and time of ingestion
• Do not induce vomiting as this may cause additional trauma or perforation 1
• Do not administer water, milk, activated charcoal, or any other substance by mouth unless specifically advised by Poison Control or emergency personnel 1
• Assess for signs of airway compromise, respiratory distress, or hemodynamic instability

Diagnostic Evaluation

• Laboratory tests should include:

  • Complete blood count (CBC)
  • Serum electrolytes (sodium, potassium, chlorine, magnesium, calcium)
  • Renal function (urea, creatinine)
  • Liver function tests
  • Arterial blood gas with pH and lactate 1

• Imaging studies:

  • Plain radiographs of neck, chest, and abdomen to assess for perforation 1
  • CT scan with contrast is recommended if perforation is suspected or if complications require surgical intervention 1, 2
  • CT findings of absence of post-contrast wall enhancement in any part of the GI tract indicates transmural necrosis requiring emergency surgery 1

Endoscopic Management

• Endoscopic evaluation should be performed in patients with persistent symptoms, even if radiographic examination is negative 1
• Timing of endoscopy depends on the severity of symptoms and suspected degree of injury:
  • Emergent endoscopy (within 2 hours) for severe symptoms or suspected significant injury
  • Urgent endoscopy (within 6 hours) for moderate symptoms 2

Surgical Management

• Surgical intervention is indicated for:

  • Perforation with extensive pleural/mediastinal contamination
  • Evidence of transmural necrosis on imaging
  • Development of complications such as mediastinitis, pleural empyema, or fistula 1

• Surgical approach depends on:

  • Location of injury
  • Patient comorbidities
  • Patient condition 1

• Minimally invasive techniques should be considered first-line treatment in referral centers when appropriate 1

Special Considerations

• Wood hardeners often contain acids, alkalis, or organic solvents that can cause corrosive injuries

• The physical form (liquid vs. solid) affects the pattern of injury:

  • Liquids transit rapidly and may cause burns to the esophagus and stomach
  • Solids tend to cause more damage to the mouth and pharynx 1

• Clinical symptoms do not always correlate with the extent of gastrointestinal damage; absence of pain or oral lesions does not rule out severe internal injury 1

Pitfalls to Avoid

• Do not delay seeking medical attention even if symptoms appear mild initially
• Do not attempt neutralization with acids or bases as this may generate heat and worsen tissue damage
• Do not administer activated charcoal as it may obscure endoscopic visualization and has not been shown to be beneficial in corrosive ingestions 1
• Do not assume the severity of injury based on oral findings alone, as esophageal and gastric injuries may be more severe than oropharyngeal findings suggest 1

Wood hardener ingestion requires prompt and specialized care due to its potentially corrosive nature. The management approach must be tailored based on the specific chemical composition of the product and the patient's clinical presentation.