QUAD #3 Pt.1: Complications of Button Battery & Caustic Ingestion with Dr. Phil Putnam

Variables that impact risk after caustic ingestions include the nature of the substance ingested, the volume ingested, the physical form of the agent, and the anatomic distribution of the agent after ingestion.

There is potential exposure to every structure from lips to duodenum after caustic ingestion.

Solid forms of caustic material tend to create more oropharyngeal exposure because of the time that it spends in the mouth.

Liquid forms of caustic material cause pharyngeal, oesophageal, gastric, and proximal duodenal injury.

Vapor forms of caustic material should be more concerning for airway injury.

Zarger grades range from normal to liquefactive necrosis.

Zarger grade 2B and above injuries are very likely to have complications associated with them.

There is evidence to support the use of dexamethasone for Zarger grade 2B injuries.

Zarger grades worse than 2B tend not to respond to steroids because they are too extensive.

Zarger grades under 2B tend not to require steroids because they are more likely to recover on their own.

Reassessment of luminal caliber and mucosal healing is important to understand whether a complication like a stricture is developing.

Dilation needs to be done cautiously because in the early periods, perforation from even fairly gentle attempts at dilation are still possible.