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If you have a burning desire to know the origins of caustic, you're already well on your way to figuring it out. Caustic was formed in Middle English as an adjective describing chemical substances, such as lime and lye, that are capable of destroying or eating away at something. The word is based on the Latin adjective causticus, which itself comes ultimately from the Greek verb kaiein, meaning "to burn." In time, caustic was baked into the English language as an adjective describing people or things (such as wit or remarks) that are bitingly sarcastic. Other kaiein descendants in English include cautery and cauterize, causalgia (a burning pain caused by nerve damage), and encaustic (a kind of paint that is heated after it's applied).

Methods: We describe a CT classification of esophageal caustic injuries: Grade I show normal esophagus; Grade IIa display internal enhancement of the esophageal mucosa and enhancement of the outer wall conferring a "target" aspect; Grade IIb present as a fine rim of external esophageal wall enhancement. In 152 patients (56 males, median age 45) who underwent esophageal preservation after caustic ingestion we compared the accuracy of the CT and endoscopic (Zargar) classifications in predicting esophageal stricture.

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Conclusion: Emergency CT outperforms endoscopy in predicting esophageal stricture formation after caustic ingestion. Emergency endoscopy evaluation after caustic ingestion is not indispensable.

At room temperature, anhydrous sodium hydroxide is a white crystalline, odorless solid that absorbs moisture from the air. It is produced as flakes, pellets, sticks, and cakes. When dissolved in water or neutralized with acid, it liberates substantial heat, which may be sufficient to ignite combustible materials. Sodium hydroxide is caustic and is one of several alkaline compounds referred to as "lye." It is generally used commercially as either the solid or as a 50% aqueous solution and should be stored in a cool, dry, well ventilated location separate from organic and oxidizing materials, acids, and metal powders.

Extreme throat swelling may require endotracheal intubation or cricothyroidotomy. Gastric lavage is useful in certain circumstances to remove caustic material and prepare for endoscopic examination. Consider gastric lavage with a small nasogastric tube if: (1) a large dose has been ingested; (2) the patient's condition is evaluated within 30 minutes; (3) the patient has oral lesions or persistent esophageal discomfort; and (4) the lavage can be administered within one hour of ingestion. Placement of the gastric tube should be guided by endoscopy because blind gastric-tube placement may further injure the chemically damaged esophagus or stomach.

Endoscopic evaluation is essential in cases of sodium hydroxide ingestion, and surgical consultation is recommended for patients who have suspected perforation. Signs and symptoms do not provide an accurate guide to the extent of injury. All patients suspected of significant caustic ingestion must have early endoscopy to assess injury to the esophagus, stomach and duodenum, and to guide subsequent management. Severe esophageal burns have occurred even in cases where burns of the mouth or oropharynx were not seen. The ingestion of large amounts of sodium hydroxide may also result in shock. Endoscopy may be contraindicated in cases where the patient is unstable, has upper airway compromise, evidence of perforation, or ingestion took place more than 48 hours previously.

The majority (68 %) of cases worldwide involve children as a result of unintentional, accidental ingestion of caustic substances. The remainder of cases reported are adults with psychiatric disturbances, some after suicide attempts, or alcoholics [1, 2].

Due to the substantial morbidity and mortality associated with these injuries, the medical community demanded legislative action. Through persistent efforts, the Federal Caustic Act of 1927 was enacted, requiring appropriate labeling of caustic substances, such as lye. Subsequently, the Poison Prevention Packaging Act of 1970 directed the US Consumer Product Safety Commission to require childproof containers and improved labeling of caustics and other potentially harmful household products. These legislative acts caused dramatic decline in the occurrence of this type of injury in developed countries. However, in developing countries the incidence is still much higher [3].

The extent of injury that results from caustic ingestion is estimated by the depth of the resultant caustic burn. First degree burns tend to involve only the mucosa, with localized redness and edema noted at endoscopy. Second degree burns involve the mucosa and sub- mucosa with blister formation evident, while third degree burns are characterized by a transmural process that affects the entire lining with findings of extensive ulceration and necrosis appearing as gangrene [10, 11].

a: Resected stomach due to perforation (arrow) after caustic material ingestion. Note diffuse thrombosis of gastro-epiploic veins. b Stomach opened longitudinally. Note necrosis of gastric mucosa

Stricture formation typically occurred 2 weeks after caustic ingestion. Management of the 66 patients with a stricture included gastrojejunostomy (n = 24), dilation with endoscope (n = 21), medical treatment (n = 10), esophagectomy (n = 5), jejunostomy (n = 4), esophago-colonic bypass (n = 1), and nasogastric feeding due to old CVA (n = 1). Of the 21 patients dilated endoscopically, 11 patients required subsequent surgery due to perforation (n = 3, one in the esophagus, two in the pyloric area) and failure of dilation (n = 8). Gastrojejunostomy were performed due to gastric outlet obstruction or EC junction stricture. The time of operation was determined by the patient's symptoms and signs. Fifty-one patients received surgery due to perforation (n = 6) and stricture (n = 34), and 11 patients required surgery after endoscopic dilation. Four deaths (in 51 patients who required surgery) were due to multiple organ failure, sepsis, or hematemesis.

Earlier studies have questioned the recommendation of routine endoscopic evaluation of all patients after presumed caustic ingestion [15,16] on the basis that in the absence of symptoms following unintentional ingestion severe injury is unlikely. The tensile strength of healing tissues in the first 3 weeks is low due to an absence of collagen. New collagen formation does not begin until the second week after injury. Thus, it is advocated that endoscopy should be avoided from 5 to 15 days after caustic ingestion [11]. Currently, EGD evaluation within 12 hours and no later than 24 hours after caustic ingestion is considered safe, and may be beneficial up to 96 hours after ingestion [17,18]. EGD is not recommended from 2 to 3 days up to 2 weeks after caustic ingestion as a result of wound softening.

On an average trip to the supermarket, shoppers may stock up on detergent, purchase a bottle of aspirin and take a look at the latest headlines on newspapers and magazines. At first glance, it may not seem like these items have much in common. However, for each of them, caustic soda plays a key role in their ingredient lists or manufacturing processes.

For regulations relating to invoices, entry, and assessment of duties, see 19 CFR parts 141, 142, 143, 151, 152. For regulations regarding the examination, classification, and disposition of foods, drugs, devices, cosmetics, insecticides, fungicides, and caustic or corrosive substances, see 19 CFR part 12. For regulations relating to consular invoices, and documentation of merchandise, see 22 CFR parts 91 and 92.

In lieu of a particular guaranty for each lot of dangerous caustic or corrosive substances, a general continuing guaranty may be furnished by the guarantor to actual or prospective purchasers. The following are forms of continuing guaranties:

The undersigned guarantees that the retail parcels, packages, or containers of the dangerous caustic or corrosive substance or substances to be sold to _____ are not misbranded within the meaning of the Federal Caustic Poison Act.

The dangerous caustic or corrosive substance or substances in retail parcels, packages, or containers suitable for household use to be sold to _____ are for other than household use, and guaranteed not to be misbranded within the meaning of the Federal Caustic Poison Act.

If a guaranty in respect to any specific lot of dangerous caustic or corrosive substances be given, it shall be incorporated in or attached to the bill of sale, invoice, or other schedule bearing the date and the name and quantity of the substance sold, and shall not appear on the label or package. The following are forms of specific guaranties:

The undersigned guarantees that the retail parcels, packages, or containers of the dangerous caustic or corrosive substance or substances listed herein (or specifying the substances) are not misbranded within the meaning of the Federal Caustic Poison Act.

The dangerous caustic or corrosive substance or substances listed herein (or specifying the substances) in retail parcels, packages, or containers suitable for household use are for other than household use and are guaranteed not to be misbranded within the meaning of the Federal Caustic Poison Act.

Authorized agents in the employ of the Department of Health and Human Services may make investigations, including the inspection of premises where dangerous caustic and corrosive substances subject to the act are manufactured, packed, stored, or held for sale or distribution, and make examinations of freight and other transportation records.

Field and frequency maps for =0.12, looking at the three reduced caustic wave numbers. Note the distinct grayscales for each graph. (a) Lowest kc in the presence of several caustic points, and single value for kc otherwise. (b) Intermediate value for kc if several caustic points exist. (c) Largest reduced caustic wave number. e24fc04721