A 54-year-old man is brought to the emergency department by his wife because of burning oral mucosal pain, chest pain, and shortness of breath that began after ingestion of an unknown substance one hour ago. The patient reports that the pain is worse when swallowing. Two years ago, he was diagnosed with major depressive disorder but does not adhere to his medication regimen. The patient does not answer questions about suicidal ideation and the substance he ingested. He works as a farmer. His wife reports that he smokes one pack of cigarettes and drinks 6 oz of homemade vodka daily. The patient is oriented to person, place, and time. His pulse is 95/min, respirations are 18/min, and blood pressure is 130/85 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 95%. Examination of the oropharynx shows profuse salivation with mild erythema of the buccal mucosa, tongue, and epiglottis area. The remainder of the examination shows no abnormalities. Which of the following is the most likely cause of this patient's clinical findings?

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Quizplus · Accepted Answer

Eductional Objective: Potassium hydroxide is an alkaline caustic agent that is a common component of drain and toilet cleaners. Caustic ingestion of alkali substances (e.g., potassium hydroxide, sodium hydroxide) can cause liquefactive necrosis with deep mucosal ulcerations. Esophageal caustic injury can be complicated by perforation of the esophageal wall, which can result in mediastinitis or peritonitis. Immediate treatment involves decontamination (removal of clothing), airway management, and fluid resuscitation with upper endoscopy within 12-24 hours of ingestion. Emetic agents and neutralization should be avoided, as these can worsen esophageal injury. Long-term complications of caustic ingestion include esophageal strictures (most common) and esophageal cancer.

A 54-Year-Old Man Is Brought to the Emergency Department by His