As early as 1927, legislation in the United States governing the packaging of lye- and acid-containing products mandated that warning labels be placed on these products. In response to the recognition that caustic exposures were more frequent in children, the Federal Hazardous Substances Act and Poison Prevention Packaging Act were passed in 1970; these acts mandated that all caustics with a concentration greater than 10% be sold in child resistant containers. By 1973, the household concentration for child-resistant packaging was lowered to 2%. In addition, the subsequent development of poison prevention education dramatically decreased the incidence of unintentional caustic injuries in children in the United States. The positive impact of both regulatory legislation and public health intervention is evident when observing the decreasing number of significant exposures in the United States49 compared to the number of exposures in developing nations that lack these policies.
In the United States, even though legislation limiting the concentration of caustics has existed since the early 20th century, exposures to both acids and alkalis continue to be significant. Data collected by the American Association of Poison Control Centers from 2007 through 2010 revealed 29,748 acid exposures and 13,800 alkali exposures. Of these, 4273 (14.4%) acid exposures and 2645 (19.2%) alkali exposures resulted in moderate to major outcomes and a total of 25 deaths occurred (Chap. 136).
In children, exposures usually consist of household products and occur in an unsupervised setting. In adults, exposures to household or industrial products may result from occupational exposure, suicide attempts, and assaults. Exposure to caustics may occur via the dermal, ocular, respiratory, and gastrointestinal routes.
Caustics cause diverse histologic and functional damage on contact with tissues depending on the tissue and caustic involved. Table 106–1 lists common caustics and the commercial products that contain them. Many are available for home use, in both solid and liquid forms, with variations in viscosity, concentration, and pH.
TABLE 106–1.Sources of Common Caustics ||Download (.pdf) TABLE 106–1. Sources of Common Caustics
|Xenobiotic ||Applications |
|Acetic acid ||Permanent wave neutralizers, photographic stop bath |
|Ammonia (ammonium hydroxide) ||Toilet bowl cleaners, metal cleaners and polishes, hair dyes and tints, antirust products, jewelry cleaners, floor strippers, glass cleaners, wax removers |
|Benzalkonium chloride ||Detergents |
|Boric acid ||Roach powders, water softeners, germicide |
|Formaldehyde, formic acid ||Deodorizing tablets, plastic menders, fumigant, embalming agent |
|Hydrochloric acid (muriatic acid) ||Metal and toilet bowl cleaners |
|Hydrofluoric acid ||Antirust products, glass etching, microchip etching |
|Iodine ||Antiseptics |
|Mercuric chloride (HgCl2) ||Preservative |
|Methylethyl ketone peroxide ||Industrial synthetic agent |
|Oxalic acid ||Disinfectants, household bleach, metal polish, antirust products, furniture refinisher |
|Phenol (creosol, creosote) ||Antiseptics, preservatives |
|Phosphoric acid ||Toilet bowl cleaners |
|Phosphorus ||Matches, fireworks, rodenticides, methamphetamine synthesis |
|Potassium permanganate ||Illicit abortifacient, antiseptic solution |
|Selenious acid ||Gun bluing agent |
|Sodium hydroxide ||Detergents, paint removers, drain cleaners and openers, oven cleaners |
|Sodium borates, carbonates, phosphates, and ...|