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Invited Commentary

Charles E. Lucas, MD
Arch Surg. 1994;129(10):1090. doi:10.1001/archsurg.1994.01420340104020.
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Ingestion of caustic substances causes widespread gastrointestinal tract injury. Bleach, detergent, and ammonia produce superficial injuries that heal primarily. A strong alkali, being tasteless and odorless, may be taken suicidally or accidentally and may cause severe esophageal injury, with or without gastric injury. A strong acid, being pungent, bitter, and offensive, is taken suicidally and causes severe stomach injury with lesser injuries to the esophagus and duodenum. The patients seen by Jeng et al exhibited the worst injury, namely, deep burn to the esophagus, stomach, and duodenum with extension to the pancreas and jejunum.

Their postinjury courses highlight four therapeutic principles that optimize a good outcome. First, this horrendous burn of the gastrointestinal tract causes not only extensive local edema but also diffuse expansion of the total interstitial space. Extensive extravascular fluid sequestration depletes the plasma volume, causing oliguria, acute renal failure, and metabolic acidosis. Before being transferred, acute renal


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