Case Definition: Caustic or Corrosive Agents

Clinical description

Ingestion of caustic or corrosive agents (e.g., phosphoric acid or sulfuric acid) can cause direct injury to tissue upon exposure, which might lead to the following signs and symptoms: oral pain, ulcerations, drooling, dysphagia, vomiting, and abdominal pain. Dermal and ocular exposure might result in local irritation or burn injury. Inhalation of corrosive gases or aspiration of agent might result in upper and lower respiratory irritation, leading to stridor, dyspnea, wheezing, and pulmonary edema (1-5).

Laboratory criteria for diagnosis

• Biologic: No biologic marker for exposure to a caustic or corrosive agent is readily available.
• Environmental: Detection of caustic or corrosive agents in environmental samples (6-9).

Case classification

• Suspected: A case in which a potentially exposed person is being evaluated by health-care workers or public health officials for poisoning by a particular chemical agent, but no specific credible threat exists.
• Probable: A clinically compatible case in which a high index of suspicion (credible threat or patient history regarding location and time) exists for a caustic or corrosive agent exposure, or an epidemiologic link exists between this case and a laboratory-confirmed case.
• Confirmed: A clinically compatible case in which laboratory tests on environmental samples are confirmatory.

The case can be confirmed if laboratory testing was not performed because either a predominant amount of clinical and nonspecific laboratory evidence of a particular chemical was present or the etiology of the agent is known with 100% certainty.

Additional resources

1. Alford BR, Harris HH. Chemical burns of the mouth, pharynx and esophagus. Ann Otol Rhinol Laryngol 1959;68:122-8.
2. Fulton J. Caustics. In: Nelson LS, Lewin NA, Howland MA, Hoffman RS, Goldfrank LR, Flomenbaum NE, eds. Goldfrank's Toxicologic Emergencies. 9th ed. New York, NY: McGraw-Hill; 2011:1364-73.
3. Salzman M, O'Malley RN. Update on the evaluation and management of caustic exposures. Emerg Med Clin North Am 2007; 25(2):459-76.
4. Cello JP, Fogel RP, Boland CR. Liquid caustic ingestion: spectrum of injury. Arch Intern Med 1980;140:501-4.
5. Crain EF, Gershel JC, Mezey AP. Caustic ingestions: symptoms as predictors of esophageal injury. Am J Dis Child 1984;138:863-5.
6. NIOSH. NIOSH manual of analytical methods [online]. 2003. [cited 2013 Apr 5]. Available from URL: http://www.cdc.gov/niosh/docs/2003-154/.
7. OSHA. Sampling and analytical methods [online]. 2010. [cited 2013 Apr 5]. Available from URL: http://www.osha.gov/dts/sltc/methods/index.html.
8. FDA. Food: Laboratory methods [online]. 2013. [cited 2013 Apr 5]. Available from URL: http://www.fda.gov/Food/FoodScienceResearch/LaboratoryMethods/default.htm.
9. EPA. Selected analytical methods: chemical methods query [online]. 2013. [cited 2013 Apr 5]. Available from URL: http://www.epa.gov/sam/searchchem.htm.