1) Treatment consists of predominantly symptomatic and supportive care. For patients with ingestion, dilution with 4- to 8 ounces of fluid may decrease symptoms. Neutralization is not recommended.
B) MANAGEMENT OF SEVERE TOXICITY
1) Although irritants by definition should not produce tissue damage, it is almost impossible to assure that a particular substance under a particular set of circumstances could not act as a corrosive instead of an irritant. Patients with severe symptoms after ingestion of an irritant should be evaluated with upper GI endoscopy for possible corrosive injury with mucous membrane damage.
C) DECONTAMINATION
1) PREHOSPITAL: The patient should be removed from the exposure; remove contaminated clothing and wash exposed skin; irrigate exposed eyes. Emesis is NOT indicated due to the irritant nature of these agents. Activated charcoal is NOT recommended.
2) HOSPITAL: Dermal or eye exposures should be irrigated as above. For patients with ingestion, dilution with 4 to 8 ounces of fluid may decrease symptoms. Emesis is NOT indicated due to the irritant nature of these agents. Charcoal is NOT recommended.
D) AIRWAY MANAGEMENT
1) Rarely, patients with signs and symptoms of respiratory failure and severe hypoxia may required intubation for acute lung injury.
E) ANTIDOTE
1) None
F) ENHANCED ELIMINATION PROCEDURE
1) There is no role for hemodialysis in irritant exposure.
G) PATIENT DISPOSITION
1) HOME CRITERIA: Patients with inadvertent small exposures who have no more than mild symptoms can be observed home.
2) OBSERVATION CRITERIA: Patients with deliberate exposures or moderate to severe symptoms should be referred to a healthcare facility for evaluation and treatment. They should be observed in the ED until asymptomatic.
3) ADMISSION CRITERIA: Patients with persistent symptoms, upper GI burns, persistent bronchospasm or hypoxia should be admitted.
4) CONSULT CRITERIA: Contact your local poison center or a medical toxicologist for any patient with severe toxicity or in whom the diagnosis is unclear.
H) PITFALLS
1) Failure to monitor patients who are at risk for delayed-onset pulmonary edema and acute lung injury. Failure to recognize corrosive rather than irritant exposure.
A) Patients should be removed from exposure into fresh air and monitored for respiratory distress. Oxygen should be administered as needed for hypoxia. Treat bronchospasm with inhaled beta-2 agonist and steroids. Patients with acute lung injury may require intubation for hypoxia; these patients should be managed with lung-protective ventilation techniques.
0.4.4 EYE EXPOSURE
A) Irrigate eyes with copious amounts of water or saline; the pH of the ocular cul de sac can be evaluated and the eyes should be irrigated until symptoms improve and this pH is neutral.
0.4.5 DERMAL EXPOSURE
A) OVERVIEW
1) Skin should be thoroughly irrigated. Contact dermatitis may arise after repeated exposure to irritants.
Rumack BH POISINDEX(R) Information System Micromedex, Inc., Englewood, CO, 2017; CCIS Volume 172, edition expires May, 2017. Hall AH & Rumack BH (Eds): TOMES(R) Information System Micromedex, Inc., Englewood, CO, 2017; CCIS Volume 172, edition expires May, 2017.
