Treatment for Sodium Hydroxide Poisoning
Immediate irrigation with copious amounts of water is the cornerstone of treatment for sodium hydroxide poisoning, followed by rapid medical evaluation for potential corrosive injuries to the gastrointestinal tract and airways. 1
Initial Management
- Ensure personal protective equipment is worn when treating sodium hydroxide exposure to avoid contamination of rescuers 1
- For dry sodium hydroxide (powder/pellets), perform dry decontamination first by brushing off as much chemical powder as possible before irrigation to prevent exothermic reaction with water 1
- Begin immediate irrigation with copious amounts of water for at least 15 minutes for external exposures 1
- Remove all contaminated clothing and jewelry to prevent continued chemical exposure 1
Airway Management
- Assess for signs of airway compromise, including aphonia, dyspnea, stridor, or respiratory distress 2
- Early intubation may be necessary for patients with signs of glottic or supraglottic edema or necrosis 2
- Tracheotomy may be required in severe cases with significant upper airway damage 2
Gastrointestinal Management
- Do NOT induce vomiting as this may cause re-exposure of the esophagus to the corrosive agent 3
- Do NOT attempt neutralization with acids as this creates an exothermic reaction that can worsen tissue damage 3
- Early evaluation of esophageal and gastric injury by rigid esophagoscopy is recommended for liquid sodium hydroxide ingestions 3
- Consider urgent laparotomy with gastrostomy for significant esophageal burns 3
- For severe gastric burns, adequate resection of damaged stomach tissue may be necessary 3
Supportive Care
- Administer intravenous fluids to maintain hydration and electrolyte balance 3
- Monitor for metabolic abnormalities including acidosis 4
- Administer intravenous steroids if significant airway edema is present 2
- Provide adequate pain management 3
Specialized Consultation
- Contact regional poison center for specific treatment recommendations and decontamination strategies 1
- Consult gastroenterology for endoscopic evaluation of injury severity 4
- Consider surgical consultation for severe cases requiring esophagectomy or gastrectomy 3
Long-term Management
- Monitor for development of strictures, which may require repeated dilatations or esophageal replacement 3
- Nutritional support may be necessary through feeding tubes for patients with significant injury 3
- Follow-up endoscopy to assess healing and development of strictures 5
Common Pitfalls and Caveats
- Severity of injury depends on concentration, volume, physical form (solid vs liquid), and duration of exposure 1
- Liquid sodium hydroxide requires more aggressive diagnostic and therapeutic approach than other caustics 3
- Delayed presentation can lead to worse outcomes; immediate treatment is essential 3
- Double exposures or ingestions can significantly complicate management and worsen prognosis 5
- CT imaging of thorax/abdomen complements endoscopy in assessing injury severity and risk of complications 4
Special Considerations
- For ocular exposure, immediate irrigation with water or commercial eye wash solution for at least 15 minutes is critical 1
- For dental exposure (as in root canal procedures), allow bleeding through the tooth to limit hematoma development 4
- In industrial settings, follow local protocols or recommendations from poison centers for specific decontamination procedures 1