(Caustic soda, alkali)

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Animals most affected
Dogs, (cats).

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Etiology
Accidental ingestion (dogs) of packaging materials used to contain household cleaning products (powders, etc.), or of products used to unblock sinks, drains and wastepipes, and in industrial detergents. Dermal and ocular discharges may occur following contact.

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Toxicity
These products are highly caustic and corrosive; incidents involving them are frequently serious and fatal.

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Clinical features
Following ingestion

• severe painful burns, inflammation and oedema of the lips, tongue, and buccal mucosae;
• vomiting, salivation;
• possibly oedema of the glottis (asphyxia);
• frequently profound shock with prostration and coma;
• colic, intense abdominal pain with diarrhoea, frequently haemorrhagic;
• following remission of the main clinical effects, secondary complications may develop: oesophageal or pyloric stenosis (cicatricial) which is slow in onset and generally fatal.

Following contact with the skin, mucosac or eyes

• formation of deep, painful, atonic skin sores, with destruction of the dermis;
• risk of erosions and ulceration (particularly of the cornea with loss of tissue and blindness).

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Lesions

• ulcerations of the buccal tissue and tongue;
• gastroenteritis with desquamation of the gastric mucosa (risk of perforation and peritonitis);
• tissues in direct contact with the chemical show desquamation, ulceration and necrosis, with inflammation, oedema and haemorrhages;
• oesophageal and pyloric stenosis;
• penetrating lesions of the cornea and conjunctiva;
• keratitis (dogs).

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Treatment
Ingestion
Induction of vomiting or gastric lavage are contraindicated

• wash the mouth out with water or diluted vinegar or a 1% acetic acid solution;
• neutralize with an oral adsorbent (activated vegetable charcoal);
• protect with gastric demulcents (e.g. aluminium hydroxide gels), antacids;
• oral administration of diluted acids (a 5% solution of acetic or citric acid) is of debatable efficacy;
• corticosteroids, antibiotics;
• myocardial stimulants;
• saline or glucose-saline infusions;
• if gastric perforation occurs, surgical intervention has not been proven to be effective.

Note: if a large volume of lye is ingested, few treatments have proven to be of any benefit.

Contact
On the skin - wash initially with large amounts of water, do not rub the skin, then rinse with a 1% solution of diluted acetic acid;
In the eye - wash with copious amounts of water, followed by physiological saline and analgesic eye drops;
topical corticosteroids, antibiotics.