Swallowed lye


• PTA – rinsed mouth with ice water/vinegar mix and spitting it out.
• Scene – Code 3 to scene, no on-scene treatment.
• En Route – 22g IV, monitor vitals. Contacted poison control and receiving hospital – recommended supportive care.
• Hospital – unknown


• Response to treatment – no changes, patient tolerated all treatment very well.
• Wong-Baker pain scale 2 throughout.


• Elliot Williams, Paramedic Woodburn Ambulance
• David Sheridan, MD Associate Professor Oregon Health and Science University
• Vladamir Novikov, Paramedic Woodburn Ambulance


• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Toni Grimes, EMT-P Woodburn Ambulance

• Ingestion
• Chemical ingestion of lye

Differential Diagnosis

• Accidental poisoning
• Lye exposure
• Chemical burn
• Tongue edema

Patient Workup

• Parents state that they were making soap at home when the father went to go get something, he came back and the patient was upset. Noticed that he had a burn on tongue. Unwitnessed event.
• Patient states – tongue hurts, throat hurts, tummy hurts. Denies breathing problems. Timeline:
• 06/16/2014 20:45:10 – stuck his finger in a bottle of lye and swallowed it.
• 06/16/2014 20:45:16 – tongue showing affects/corrosive.
• 06/16/2014 20:45:24 – unknown how much went in his throat.
• 06/16/2014 20:45:32 – sips ice water/rinsing with water.

Physical Exam

• GSC – 15
• CBG – 86
• EKG – sinus tach
• Wong-Baker pain scale – 2 throughout
• Chemical burn on tongue, no redness or swelling in throat visible
• Otherwise atraumatic and unremarkable

Editor’s Notes

Patient care prevented video en route or on scene. Video taken in exam room at ED after talking with patient’s mom.

Suggested Approach

• Lye is a strongly alkali material that is used for household hold purposes including homemade soap.
• The initial assessment emphasizes the classic ABCs with a focus on airway.
• The extent of injury is a spectrum. It may involve the entire throat or airway. In the worst case, a child may be drooling due to inflammation or have stridor from upper airway irritation. Therefore, the initial questions should focus on how much the child ingested or where on their body the exposure was. For example, did the child drink a bottle of the agent or simply touch his finger to his tongue or mouth?
• Assessing the child’s breathing and their ability to tolerate secretions will be paramount to direct the urgency of evaluation in the emergency department and possible interventions you may need in the field including airway management.
• Often a child with a significant ingestion will require an endoscopic evaluation by gastroenterology; therefore, ensure the child remains NPO as soon as you arrive.
• Encouraging the child to vomit is contraindicated as this causes a second exposure of the tissue to the agent as it come back out.
• Contacting the local poison center can be very helpful in case there are recommended interventions prior to arrival in the emergency department depending on type of exposure and body area.

Suggested references

• Caustic Ingestions Treatment & Management


• Gender: Male
• Age: 4 years
• Height: Not Available
• Weight: 40.1 lb/18.2 kg


• Temperature: Not Available
• Blood Pressure: 133/76
• Heart Rate: 107
• Respiratory Rate: 24
• Pulse Oximetry: 99% RA
Signs and Symptoms
Tongue and throat pain; abdominal pain


• PMH: Croup 4 months ago
• Allergies: NKA
• Dispatch info: 5 yom c/b/a swallowed lye


• Lives with family at home


• None

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