Every year large numbers of children accidentally ingest lye.26 Most make a full recovery, a few die, and many more suffer severe injury requiring surgical intervention and sequelae that may accompany them the rest of their lives.
Occasionally, adults attempt and sometimes succeed in committing suicide by ingestion of lye (Figure 23.4).
The severity of injuries depends in part on the form of the lye ingested. Originally, it was available only in a crystalline form. Accidental ingestion was difficult, because only a few crystals caused severe pain, prompting a rapid cessation of such intake. Individuals attempting suicide commonly diluted the crystals with water to produce a solution of relatively low alkaline concentrations. Thus, the injuries produced were generally limited to the esophagus and were relatively superficial. Injury to the stomach was uncommon. Esophageal stricture was the most common complication, with occasional perforation. Lye is now available in a liquid form that is colorless and odorless. It can produce transmural necrosis of the esophagus after only 1 s of contact. Liquid lye commonly reaches the stomach, producing gastric necrosis. Occasionally, perforation of the small intestine can occur. In a case seen by one of the authors, a 41-year-old woman exsanguinated 4 weeks after ingesting liquid lye, when she developed an esophagoaortic fistula.
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