Based on the available literature, there is a risk for accidental and intentional exposure to solid sodium hydroxide or to irritating or corrosive solutions of sodium hydroxide. Fifty-six female rats were allocated into three groups: Group uninjured and untreated (baseline control, n = 8) rats were uninjured and untreated, Group sodium hydroxide (positive control, n = 24) rats were injured but untreated and Group EPO (erythropoietin-treated, n = 24) rats were injured and given subcutaneous erythropoietin (1,000 IU/kg per day), 15 min, 24, and 48 hr after administration of the sodium hydroxide solution. Solutions of 25 to 50 percent concentration will produce an immediate burn. The study by Christesen 15) also found that complications only developed in children who had ingested strong alkalis (sodium hydroxide, ammonia and dishwasher products). 1995. At the hospital, initial examination showed vision limited to light perception, corneal clouding to such an extent that iris markings were not discernable, necrosis of most of the bulbar conjunctiva, some sloughing in the nasal area of the cornea, blanched and necrotic cul-de-sac, and some involvement of the lids and adjacent skin. JACEP 8:329-336, Mallory A and Schaefer JW. Toxicology of the eye 4th ed. At this time the cornea was slightly clearer. Is endoscopy always necessary? Dust formation is unlikely because of hygroscopic properties. Gastric injury may also occur. Following … Of these patients, 2 developed esophageal strictures, but subsequent dilatation was successful. 1993. It can be stated that sodium hydroxide will neither reach the fetus nor reach male and female reproductive organs, which shows that there is no risk for developmental toxicity and no risk for toxicity to reproduction. Six animals from Group sodium hydroxide and six from Group erythropoietin-treated were killed at 4, 24, 48, and 72 hours after application of sodium hydroxide to the esophagus. Charles C Thomas, Springfield Illinois, Sodium hydroxide. Lesions in the esophagus were found in 93 patients. 1989. Thus, upon contact with eyes, washing with water must be started within 10 seconds and continued for at least 15 minutes to prevent permanent injury. Mutagenic for mammalian somatic cells. Alkalis cause liquifactive necrosis with saponification of fats and solubilisation of proteins. When sodium hydroxide (caustic soda) comes into contact with the skin it does not usually cause immediate pain, but it does start to cause immediate damage. They combine with cell membrane lipids which causes disruption of the cells and stromal mucopolysaccharides with concomitant tissue softening. Pediatr Surg Int. Sodium hydroxide is very corrosive. It is greatest where the pH is above 12. Clinitest(R) tablets also adhere to the esophagus either because of thermal coagulation or because of the carbon dioxide bubbles produced from the reaction of the citric acid and sodium hydroxide present 19). Ensure that adequate decontamination has been carried out. From January 1984 to June 1991 a total number of 24 patients were treated for sodium hydroxide related eye injury in the Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. The two most common ways to become injured by sodium hydroxide is either by contact (skin or eyes), or by inhaling a vapor containing high levels of the compound. Methylprednisolone was given by retrobulbar and subconjunctival injection. All of animals in Group uninjured and untreated were killed 4 hour after exposure to 0.9% NaCl (sodium chloride or saline). Sodium hydroxide is a manufactured substance and sodium hydroxide [Na(OH)] is sold as a solid (cast, flakes, pearls, compounders) or as solutions with varying concentrations. 1977. The esophageal mucosa was bleeding and circumferential second and third degree burns were present. It is used as a pipe line cleaner in dairies, bars and public houses. Although main quantities are used by the industry (large enterprises) it is also widely used by small and medium sized enterprises. The inhalation of aerosols of 5 % sodium hydroxide by a 25-year-old women resulted in irreversible obstructive lung injury after working for one day in a poorly ventilated room 52). Synonyms: Caustic soda, Sodium hydrate, lye. Furthermore the uptake of sodium, via exposure to sodium hydroxide, is much less than the uptake of sodium via food under these conditions. She did not experience any pain until nearly 2 hours later. (1985), Ann Otol Rhinol Laryngol, 94, 337-341, IPCS; UK Poisons Information Document: Sodium Hydroxide (1310-73-2). Topical irrigation was repeated and he was transferred to the operating room where intraocular irrigation was commenced. Can cause severe irritation of the nose and throat. An X-ray showed perforation of the stricture. 200 patients with suspected caustic ingestation were examined 40). Perform CPR if necessary. View entire discussion ( 13 comments) More posts from the SkincareAddiction community. pH 7 means neutral. Sodium hydroxide is present as a stabilizing agent in bleach. Acta Paediatr 84:1177-1182, Knopp R. 1979. Small amounts of sodium hydroxide are produced as a by-product and released into the car interior when motor car air bag systems are activated. About 2 hour later he suffered immediate retrosternal pain. Two weeks after the injury aspiration-irrigation of the cataract was undertaken with an improvement in visual acuity. Oral ingestion of sodium hydroxide, which occurs frequently in children, causes severe tissue necrosis, with stricture formation of the esophagus, often resulting in death 25). Consequences of caustic ingestions in children. The amount of 20 mg sodium hydroxide is equivalent with 11.5 mg sodium which is a negligible amount compared to the daily dietary exposure of 3.1-6.0 g. The amount of 20 mg sodium hydroxide is equivalent with 0.5 mmole and if this amount would be taken up in the blood stream it would result in a concentration of 0.1 mM hydroxyl (OH–) ion (assuming 5 liter blood per human). Eye irritation data are available for animals. These effects result in adherence and deep penetration into the tissues. Analytical measurements, to determine the inhalation exposure of workers during production and use, seem to be unavailable. Sodium hydroxide is corrosive to all tissues. In studies using rabbits, application to the skin of a 5% solution caused severe necrosis after 4 hours. OJ L 295, 12.11.2011, p. 178. Pain and irritation are evident within 3 minutes, but contact with dilute solutions may not cause symptoms for several hours. In studies using rabbits, instillation by oral intubation caused within 10 seconds: erosion into the stomach muscle with 12% solutions; perforation with 28% solutions; and no damage with 1% solutions. An esophagoscopy at five weeks post-ingestion revealed esophageal narrowing. Permanent scarring can result. The area was irrigated for 60 minutes. On arrival about 30 minutes later he had retrosternal pain and had difficulty swallowing. It fails to coagulate protein which would serve to prevent further penetration. The major human health hazard (and the mode of action) of sodium hydroxide is local irritation and/or corrosion on skin and eye irritation/corrosion. Sodium hydroxide is used to manufacture soaps, rayon, paper, explosives, dyestuffs, and petroleum products. Although this method is not currently used (except internally by some manufacturers to classify products as irritant or corrosive) it appears to be a better predictor of injury than pH. Follow up six weeks later revealed good healing and no complications. Available from, as of October 5, 2011:, Organization for Economic Cooperation and Development; Screening Information Data Set for Sodium Hydroxide, (1310-73-2) p.13 (March 2002). If this chemical (or liquids containing this chemical) contacts the skin, promptly wash the contaminated skin with soap and water. Alkaline reserve (which is the amount of a standard acid solution needed to titrate an alkali to a specified pH usually pH 8, the pH of normal esophageal mucosa) has been found to correlate better than pH with the production of caustic esophageal injury 10).
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