Medical Management Guidelines for Sodium Hydroxide (NaOH)
CAS# 1310-73-2
UN# 1823 (solid), 1824 (solution)
PDF Versionpdf icon[190 KB]
Synonyms include caustic soda, lye, soda
lye, and sodium hydrate.
- Persons whose clothing or skin is contaminated with solid
sodium hydroxide or its solutions can secondarily contaminate
rescuers by direct contact.
- Sodium hydroxide is a white, noncombustible solid that
absorbs moisture from the air. When the solid is in contact
with water, it may generate sufficient heat to ignite combustible
materials. The solid and its solutions are corrosive. Sodium
hydroxide is odorless; thus, odor provides no warning of
hazardous concentrations.
- Sodium hydroxide does not produce systemic toxicity, but
is very CORROSIVE and can cause severe burns in all tissues
that it comes in contact with. Sodium hydroxide poses a
particular threat to the eyes, since it can hydrolyze protein,
leading to severe eye damage.
General Information
Description
At room temperature, anhydrous sodium
hydroxide is a white crystalline, odorless solid that absorbs
moisture from the air. It is produced as flakes, pellets,
sticks, and cakes. When dissolved in water or neutralized
with acid, it liberates substantial heat, which may be sufficient
to ignite combustible materials. Sodium hydroxide is caustic
and is one of several alkaline compounds referred to as "lye."
It is generally used commercially as either the solid or as
a 50% aqueous solution and should be stored in a cool, dry,
well ventilated location separate from organic and oxidizing
materials, acids, and metal powders.
Routes of Exposure
Inhalation
Inhalation of sodium hydroxide dust,
mist, or aerosol may cause irritation of the mucous membranes
of the nose, throat, and respiratory tract. Sodium hydroxide
is odorless; thus, odor provides no warning of hazardous
concentrations. Mucous membrane irritation occurs at the
OSHA PEL (2 mg/m3) and is generally an adequate warning
property for acute exposure to sodium hydroxide. However,
workers exposed to prolonged or recurrent mists or aerosols
of sodium hydroxide can become somewhat tolerant of the irritant
effects. Sodium hydroxide of sufficient strength can hydrolyze
proteins in tissues and can kill cells in tissues.
Children exposed to the same levels of
sodium hydroxide in air as adults may receive a larger dose
because they have greater lung surface area:body weight ratios
and increased minute volumes:weight ratios. In addition, they
may be exposed to higher levels than adults in the same location
because of their short stature and the higher levels of sodium
hydroxide in air found nearer to the ground.
Skin/Eye Contact
Exposure to sodium hydroxide solid or
solution can cause skin and eye irritation. Direct contact
with the solid or with concentrated solutions causes thermal
and chemical burns leading to deep-tissue injuries. Very strong
solutions of sodium hydroxide can hydrolyze proteins in the
eyes, leading to severe burns and eye damage or, in extreme
cases, blindness.
Children are more vulnerable to toxicants
affecting the skin because of their relatively larger surface
area: body weight ratio.
Ingestion
Ingestion of sodium hydroxide can cause
severe corrosive injury to the lips, tongue, oral mucosa,
esophagus, and stomach.
Sources/Uses
Sodium hydroxide is produced by the electrolysis
of aqueous solutions of sodium chloride (brine) or by reacting
naturally occurring sodium carbonate with calcium hydroxide.
Sodium hydroxide is used to manufacture
soaps, rayon, paper, explosives, dyestuffs, and petroleum
products. It is also used in processing cotton fabric, laundering
and bleaching, metal cleaning and processing, electroplating,
oxide coating, and electrolytic extracting. It is commonly
present in commercial drain and oven cleaners.
Standards and Guidelines
OSHA PEL (permissible exposure limit)
= 2 mg/m3 (averaged over an 8-hour workshift)
NIOSH IDLH (immediately dangerous to
life or health) = 10 mg/m3
AIHA ERPG-2 (emergency response planning
guideline) (maximum airborne concentration below which it
is believed that nearly all individuals could be exposed for
up to 1 hour without experiencing or developing irreversible
or other serious health effects or symptoms which could impair
an individual's ability to take protective action) = 5 mg/m3
Physical Properties - Calcium Hypochlorite
Description: Colorless-to-white,
odorless, solid that absorbs moisture from the air.
Warning properties: Inadequate;
no odor. Mucous membrane irritation at 2 mg/m3.
Molecular weight: 40.0 daltons
Boiling point (760 mm Hg): 2,534°F
(1,390°C)
Freezing point: 605°F (318°C)
Specific gravity: 2.13 (water
= 1)
Vapor pressure: 0 mm Hg at 68°F
(20°C)
Water solubility: 111% at 68°F
(20°C)
Flammability: Noncombustible solid,
but when in contact with water, it may generate enough heat
to ignite combustible materials.
Incompatibilities
Sodium hydroxide dissolves easily in
water generating a great deal of heat. It reacts with acids
(also generating a lot of heat); halogenated organic compounds;
metals such as aluminum, tin, and zinc; and nitromethane.
Sodium hydroxide is corrosive to most metals.
Health Effects
- Sodium hydroxide is strongly irritating and corrosive.
It can cause severe burns and permanent damage to any tissue
that it comes in contact with. Sodium hydroxide can cause
hydrolysis of proteins, and hence can cause burns in the
eyes which may lead to permanent eye damage.
- Inhaled sodium hydroxide can cause swelling of the larynx
and an accumulation of fluid in the lungs.
- Stridor, vomiting, drooling, and abdominal pain are early
symptoms of sodium hydroxide ingestion. Ingestion may lead
to perforation of the gastrointestinal tract and shock.
- Sodium hydroxide does not produce systemic toxicity; its
health effects are due to its corrosive nature.
Acute Exposure
Sodium hydroxide is strongly irritating
and corrosive. It can cause severe burns and permanent damage
to any tissue that it comes in contact with. The extent of
damage to the gastrointestinal tract may not be clear until
several hours after ingestion. Inhaled sodium hydroxide can
cause swelling of the larynx and an accumulation of fluid
in the lungs. Contact with 25-50% solutions produces immediate
irritation, while after contact with solutions of 4% or less,
irritation may not develop for several hours. It may not be
possible to correctly ascertain the degree of damage to eyes
for up to 72 hours after exposure.
Children do not always respond to chemicals
in the same way that adults do. Different protocols for managing
their care may be needed.
Respiratory
Inhalation of sodium hydroxide is immediately
irritating to the respiratory tract. Swelling or spasms of
the larynx leading to upper-airway obstruction and asphyxia
can occur after high-dose inhalation. Inflammation of the
lungs and an accumulation of fluid in the lungs may also occur.
Children may be more vulnerable to corrosive
agents than adults because of the relatively smaller diameter
of their airways.
Children may be more vulnerable because
of relatively increased minute ventilation per kg and failure
to evacuate an area promptly when exposed.
People with asthma or emphysema may be
more susceptible to the toxicity of this agent.
Dermal
Skin contact with solid sodium hydroxide or its concentrated solutions can cause severe burns with deep ulcerations. Burns appear soft and moist and are very painful. Although contact with concentrated solutions causes pain and irritation within 3 minutes, contact with dilute solutions may not cause symptoms for several hours.
Because of their relatively larger surface area:body weight ratio, children are more vulnerable to toxicants affecting the skin.
Ocular
Eye exposure may produce diffuse or localized
blood vessel clots and an accumulation of fluid in the eye.
Softening, sloughing, and ulcerations of the cornea may occur.
Ulcerations may continue to progress for many days. Severe
injury can lead to clouding of the eye surface and blindness.
Gastrointestinal
Ingestion of sodium hydroxide can cause
spontaneous vomiting, chest and abdominal pain, and difficulty
swallowing with drooling. Corrosive injury to the mouth, throat,
esophagus, and stomach is extremely rapid and may result in
perforation, hemorrhage, and narrowing of the gastrointestinal
tract.
Potential Sequelae
Cataracts, glaucoma, adhesion of the
eyelid to the cornea, blindness, and loss of the eye may occur
after eye exposure.
Cancer of the esophagus has been reported
15 to 40 years after the formation of corrosion-induced strictures.
However, it is believed that these cancers were the result
of tissue destruction and scar formation rather than a direct
cancer-causing action of sodium hydroxide.
Severe inhalation injuries may cause
persistent hoarseness and reactive airways dysfunction syndrome
(RADS), a chemically- or irritant-induced type of asthma.
Chronic Exposure
Chronic exposure to dusts or mists of
sodium hydroxide may lead to ulceration of the nasal passages.
Chronic skin exposures can lead to dermatitis. Ingestion may
lead to perforation of the gastrointestinal tract or stricture
formation.
Chronic exposure may be more serious
for children because of their potential longer latency period.
Carcinogenicity
Sodium hydroxide has not been classified
for carcinogenic effects. See Potential Sequelae above.
Reproductive and Developmental Effects
Sodium hydroxide dissociates within the
body and would not reach the reproductive organs in an unchanged
state. No data were located concerning reproductive endpoints
in humans exposed to sodium hydroxide. Sodium hydroxide is
not teratogenic in rats. Sodium hydroxide is not included
in Reproductive and Developmental Toxicants, a 1991
report published by the U.S. General Accounting Office (GAO)
that lists 30 chemicals of concern because of widely acknowledged
reproductive and developmental consequences.
Prehospital Management
- Victims whose clothing or skin is contaminated with sodium
hydroxide solid or solutions can secondarily contaminate
response personnel by direct contact. Victims do not pose
risks of secondary contamination after clothing is removed
and the skin is washed.
- Sodium hydroxide is corrosive to tissues. When mists or
aerosols of sodium hydroxide are inhaled, laryngeal edema
and noncardiogenic pulmonary edema can result. Extensive
skin burns or gastrointestinal-tract injury from ingestion
may compromise fluid balance, causing shock; early clinical
appearance may not predict this event. Stridor, vomiting,
painful swallowing, drooling, and abdominal pain are early
symptoms of sodium hydroxide ingestion.
- There is no antidote for sodium hydroxide. Treatment consists
of respiratory and cardiovascular support.
Hot Zone
Rescuers should be trained and appropriately
attired before entering the Hot Zone. If the proper equipment
is not available, or if rescuers have not been trained in
its use, assistance should be obtained from a local or regional
HAZMAT team or other properly equipped response organization.
Rescuer Protection
Sodium hydroxide is a severe respiratory-tract
and skin irritant.
Respiratory Protection: Positive-pressure,
self-contained breathing apparatus (SCBA) is recommended in
response situations that involve exposure to potentially unsafe
levels of sodium hydroxide.
Skin Protection: Chemical-protective
clothing is recommended because sodium hydroxide can cause
irritation or skin burns.
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. If trauma is suspected, maintain
cervical immobilization manually and apply a cervical collar
and a backboard when feasible.
Victim Removal
If victims can walk, lead them out of
the Hot Zone to the Decontamination Zone. Victims who are
unable to walk may be removed on backboards or gurneys; if
these are not available, carefully carry or drag victims to
safety.
Consider appropriate management of chemically
contaminated children, such as measures to reduce separation
anxiety if a child is separated from a parent or other adult.
Decontamination Zone
All victims require decontamination as
described below.
Rescuer Protection
If exposure levels are determined to
be safe, decontamination may be conducted by personnel wearing
a lower level of protection than that worn in the Hot Zone
(described above).
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. Stabilize the cervical spine
with a collar and a backboard if trauma is suspected. Administer
supplemental oxygen as required. Assist ventilation with a
bag-valve-mask device if necessary.
Basic Decontamination
Rapid decontamination is critical.
Victims who are able may assist with their own decontamination.
Rescuers should wear protective clothing and gloves while
treating patients whose skin is contaminated with sodium hydroxide.
Immediately brush any solid material
from clothes, skin, or hair while protecting the victim's
eyes. Quickly remove contaminated clothing and flush exposed
areas with water for at least 15 minutes. Double-bag contaminated
clothing and personal belongings. Use caution to avoid hypothermia
when decontaminating children or the elderly. Use blankets
or warmers when appropriate.
Flush exposed or irritated eyes with
plain water or saline for at least 30 minutes. Remove contact
lenses if easily removable without additional trauma to the
eye, otherwise sodium hydroxide trapped beneath the lens will
continue to damage the eye. If pain or injury is evident,
continue irrigation while transferring the victim to the Support
Zone.
In cases of ingestion, do not induce
emesis. Do not administer activated charcoal or attempt
to neutralize stomach contents.
Victims who are conscious and able to
swallow can be given 4 to 8 ounces of milk or water; if the
patient is symptomatic, delay decontamination until other
emergency measures have been instituted.
Consider appropriate management of chemically contaminated
children at the exposure site. Provide reassurance to the
child during decontamination, especially if separation from
a parent occurs.
Transfer to Support Zone
As soon as basic decontamination is complete,
move the victim to the Support Zone.
Support Zone
Be certain that victims have been decontaminated
properly (see Decontamination Zone above). Victims
who have undergone decontamination pose no serious risks of
secondary contamination to rescuers. In such cases, Support
Zone personnel require no specialized protective gear.
ABC Reminders
Quickly access for a patent airway. If
trauma is suspected, maintain cervical immobilization manually
and apply a cervical collar and a backboard when feasible.
Ensure adequate respiration and pulse. Administer supplemental
oxygen as required and establish intravenous access if necessary.
Place on a cardiac monitor.
Additional Decontamination
Continue irrigating exposed skin and
eyes, as appropriate.
In cases of ingestion, do not induce
emesis. Do not administer activated charcoal or attempt
to neutralize stomach contents.
Victims who are conscious and able to
swallow can be given 4 to 8 ounces of milk or water if this
has not been given previously; if the patient is symptomatic,
delay decontamination until other emergency measures have
been instituted.
Advanced Treatment
In cases of respiratory compromise secure
airway and respiration via endotracheal intubation. If not
possible, perform cricothyroidotomy if equipped and trained
to do so. Avoid blind nasotracheal intubation or the use of
an esophageal obturator. Use direct visualization to intubate.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Consider the health of the myocardium before
choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly). Sodium hydroxide poisoning is not known to
pose additional risk during the use of bronchial or cardiac
sensitizing agents.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or are having seizures or cardiac arrhythmias should be treated
according to advanced life support (ALS) protocols.
Transport to Medical Facility
Only decontaminated patients should be
transported to a medical facility. "Body bags" are
not recommended.
Report to the base station and the receiving
medical facility the condition of the patient, treatment given,
and estimated time of arrival at the medical facility.
If a chemical has been ingested, prepare
the ambulance in case the victim vomits toxic material. Have
ready several towels and open plastic bags to quickly clean
up and isolate vomitus.
Multi-Casualty Triage
Consult with the base station physician
or the regional poison control center for advice regarding
triage of multiple victims.
Patients with evidence of ingestion or
substantial inhalation exposure or who have evidence of eye
or skin burns should be transported to a medical facility
for evaluation. Others may be discharged from the scene after
their names, addresses, and telephone numbers are recorded.
Those discharged should be advised to seek medical care promptly
if symptoms develop (see Patient Information Sheet
below).
Emergency Department Management
- Patients who have sodium hydroxide solid or solution on
their skin or clothing can secondarily contaminate hospital
personnel by direct contact. Patients do not pose risks
of secondary contamination after clothing is removed and
the skin is washed.
- Sodium hydroxide is corrosive to tissues. The severity
of sodium hydroxide burns may not be readily apparent until
24 to 48 hours after exposure.
- Stridor, vomiting, drooling, and abdominal pain are early
symptoms of sodium hydroxide ingestion. Patients who have
ingested sodium hydroxide may progress to shock. Patients
who have inhaled mists or aerosols of sodium hydroxide may
experience laryngeal edema and noncardiogenic pulmonary
edema.
- There is no antidote for sodium hydroxide. Treatment consists
of respiratory and cardiovascular support.
Decontamination Area
Unless previously decontaminated, all
patients suspected of contact with solid sodium hydroxide
or its solutions and all victims with skin or eye irritation
require decontamination as described below. Because sodium
hydroxide is extremely corrosive, hospital personnel should
don rubber gloves, rubber aprons, and eye protection before
treating contaminated patients. All other patients may be
transferred to the Critical Care area.
Be aware that use of protective equipment
by the provider may cause fear in children, resulting in decreased
compliance with further management efforts.
Because of their relatively larger surface
area:body weight ratio, children are more vulnerable to toxicants
affecting the skin. Also, emergency room personnel should
examine children's mouths because of the frequency of hand-to-mouth
activity among children.
ABC Reminders
Evaluate and support airway, breathing,
and circulation. Children may be more vulnerable to corrosive
agents than adults because of the smaller diameter of their
airways. Administer 100% humidified supplemental oxygen to
patients who have hypoxemia. In cases of respiratory compromise
secure airway and respiration via endotracheal intubation.
Because of possible corrosive injury, intubation should be
done carefully. If not possible, surgically create an airway.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Consider the health of the myocardium before
choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly). Sodium hydroxide poisoning is not known to
pose additional risk during the use of bronchial or cardiac
sensitizing agents.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or have seizures or ventricular arrhythmias should be treated
in the conventional manner.
Basic Decontamination
Rapid decontamination is critical.
Patients who are able may assist with their own decontamination.
Immediately brush any solid material
from clothes, skin, or hair while protecting the victim's
eyes. Quickly remove contaminated clothing and flush exposed
areas with water for at least 15 minutes. Double-bag contaminated
clothing and personal belongings. Use caution to avoid hypothermia
when decontaminating children or the elderly. Use blankets
or warmers when appropriate.
Flush exposed or irritated eyes with
plain water or saline for at least 30 minutes. Remove contact
lenses if easily removable without additional trauma to the
eye. If a corrosive material is suspected or if pain or injury
is evident, continue irrigation while transferring the victim
to the Critical Care Area.
In cases of ingestion, do not induce
emesis. Do not administer activated charcoal or attempt
to neutralize stomach contents.
Victims who are conscious and able to
swallow can be given 4 to 8 ounces of milk or water if this
has not been given previously (see Critical Care Area
below for more information on ingestion exposure).
Critical Care Area
Be certain that appropriate decontamination
has been carried out (see Decontamination Area above).
ABC Reminders
Evaluate and support airway, breathing,
and circulation as in ABC Reminders above. Children
may be more vulnerable to corrosive agents than adults because
of the smaller diameter of their airways. Establish intravenous
access in seriously ill patients if this has not been done
previously. Continuously monitor cardiac rhythm.
Patients who are comatose, hypotensive,
or have seizures or cardiac arrhythmias should be treated
in the conventional manner.
Inhalation Exposure
Administer supplemental oxygen by mask
to patients who have respiratory symptoms. Treat patients
who have bronchospasm with aerosolized bronchodilators. The
use of bronchial sensitizing agents in situations of multiple
chemical exposures may pose additional risks. Consider the
health of the myocardium before choosing which type of bronchodilator
should be administered. Cardiac sensitizing agents may be
appropriate; however, the use of cardiac sensitizing agents
after exposure to certain chemicals may pose enhanced risk
of cardiac arrhythmias (especially in the elderly). Sodium
hydroxide poisoning is not known to pose additional risk during
the use of bronchial or cardiac sensitizing agents.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Skin Exposure
Skin burns from sodium hydroxide should
be irrigated frequently with normal saline for 24 hours. Consider
early (within 1 hour of exposure) institution of continuous
hydrotherapy. Neutralizing substances should not be used.
Fluid resuscitation should be provided as for comparable thermal
burns; keeping in mind that the full extent of the sodium
hydroxide burn may not be accurately assessed for 24 to 48
hours and may be underestimated initially.
Because of their relatively larger surface
area:body weight ratio children are more vulnerable to toxicants
affecting the skin.
Eye Exposure
Continue eye irrigation until the pH
of the conjunctival sac is neutral (pH 7). The pH of the conjunctiva
should be checked every 30 minutes for 2 hours after irrigation
is stopped to ensure that the measured pH is that of the tissue
and not the irrigating fluid. Ensure that any particulate
matter has been removed. A mydriatic-cycloplegic medication
such as homatropine should be used to prevent synechiae. Examine
the eyes for conjunctival or corneal damage and treat appropriately.
Immediately consult an ophthalmologist for patients who have
eye exposure.
Ingestion Exposure
In cases of ingestion, do not induce
emesis. Do not administer activated charcoal or attempt
to neutralize stomach contents.
Victims who are conscious and able to
swallow can be given 4 to 8 ounces of milk or water if this
has not been given previously.
Extreme throat swelling may require endotracheal
intubation or cricothyroidotomy. Gastric lavage is useful
in certain circumstances to remove caustic material and prepare
for endoscopic examination. Consider gastric lavage with a
small nasogastric tube if: (1) a large dose has been ingested;
(2) the patient's condition is evaluated within 30 minutes;
(3) the patient has oral lesions or persistent esophageal
discomfort; and (4) the lavage can be administered within
one hour of ingestion. Placement of the gastric tube should
be guided by endoscopy because blind gastric-tube placement
may further injure the chemically damaged esophagus or stomach.
Endoscopic evaluation is essential in
cases of sodium hydroxide ingestion, and surgical consultation
is recommended for patients who have suspected perforation.
Signs and symptoms do not provide an accurate guide to the
extent of injury. All patients suspected of significant caustic
ingestion must have early endoscopy to assess injury to the
esophagus, stomach and duodenum, and to guide subsequent management.
Severe esophageal burns have occurred even in cases where
burns of the mouth or oropharynx were not seen. The ingestion
of large amounts of sodium hydroxide may also result in shock.
Endoscopy may be contraindicated in cases where the patient
is unstable, has upper airway compromise, evidence of perforation,
or ingestion took place more than 48 hours previously.
Perforation almost always requires surgical
repair.
Because children do not ingest large
amounts of corrosive materials, and because of the risk of
perforation from NG intubation, lavage is discouraged in children
unless performed under endoscopic guidance.
Toxic vomitus or gastric washings should
be isolated (e.g., by attaching the lavage tube to isolated
wall suction or another closed container).
Antidotes and Other Treatments
There is no antidote for sodium hydroxide.
Various treatments to decrease stricture formation have been
proposed (including administration of ascorbic acid and steroids),
but are not recommended.
Laboratory Tests
The diagnosis of acute sodium hydroxide
toxicity is primarily clinical, based on symptoms of corrosive
injury. However, laboratory testing is useful for monitoring
the patient and evaluating complications. Routine laboratory
studies for all exposed patients include CBC, glucose, and
electrolyte determinations. Patients who have respiratory
complaints may require chest radiography and pulse oximetry
(or ABG measurements). Patients with symptoms of severe burns
or perforation may require renal function tests and blood
typing.
Disposition and Follow-up
Consider hospitalizing patients who have
ingested sodium hydroxide or who have eye or serious skin
burns or histories of significant inhalation exposure. Patients
with signs of perforation may require emergency surgery. Those
with significant dermal injury should be admitted to the burn
unit and patients with significant ingestion may need admission
to the intensive care unit.
Delayed Effects
Injury may continue to progress in severity
for up to 48 hours after exposure. Patients may develop upper
airway obstruction, perforation, and shock.
Severe inhalation injuries may cause
persistent hoarseness and reactive airways dysfunction syndrome
(RADS), a chemically- or irritant-induced type of asthma.
Patient Release
Patients who have minimal skin exposure
or patients who show no progressive symptoms 6 to 12 hours
after a mild-to-moderate inhalation exposure may be discharged
with instructions to seek medical care promptly if symptoms
develop (see the Sodium Hydroxide-Patient Information Sheet
below).
Follow-up
Obtain the name of the patient's primary
care physician so that the hospital can send a copy of the
ED visit to the patient's doctor.
For patients who have ingested sodium
hydroxide, esophagoscopy should be performed within 48 hours
of ingestion to assess severity of injury; a flexible instrument
should be used. If perforation has not occurred, consider
follow-up endoscopy or a barium swallow 10 days to 3 weeks
after the initial burn to further assess the injury.
Patients who have corneal, conjunctival,
scleral, or lid lesions should be reexamined within 24 hours.
Reporting
If a work-related incident has occurred,
you may be legally required to file a report; contact your
state or local health department.
Other persons may still be at risk in
the setting where this incident occurred. If the incident
occurred in the workplace, discussing it with company personnel
may prevent future incidents. If a public health risk exists,
notify your state or local health department or other responsible
public agency. When appropriate, inform patients that they
may request an evaluation of their workplace from OSHA or
NIOSH. See Appendices III and IV for a list of agencies that
may be of assistance.
Patient Information Sheet
This handout provides information and
follow-up instructions for persons who have been exposed to
sodium hydroxide.
Print this handout only.pdf icon[46.4 KB]
What is sodium hydroxide?
Sodium hydroxide is a white, solid material
that picks up moisture from the air. If put in water, it produces
a large amount of heat. Both the solid and its solutions are
very corrosive and can cause severe burns. Sodium hydroxide
is a member of a group of chemical compounds also known as
bases or alkalies, which can neutralize and are neutralized
by, acids, releasing a lot of heat.
What immediate health effects can be caused by exposure to sodium hydroxide?
Solid sodium hydroxide or strong solutions
produce immediate pain when they come in contact with any
part of the body. Weak solutions may not produce pain for
several hours, but serious burns can result even from weak
solutions if they are not washed off quickly. Spilling sodium
hydroxide over large areas of the skin or swallowing sodium
hydroxide may cause shock and even death. Sodium hydroxide
can break down proteins and generates heat when dissolving
in water. Contact with sensitive tissues, such as the eyes,
is particularly dangerous and can cause permanent damage or
even blindness.
Can sodium hydroxide poisoning be treated?
There is no antidote for sodium hydroxide,
but the burns and shock it can cause can be treated. Patients
who develop serious symptoms need to be hospitalized.
Are any future health effects likely to occur?
A single small exposure from which a
person recovers quickly is not likely to cause delayed or
long-term effects. After a serious exposure to large areas
of the skin, scarring may occur that will require skin grafts.
A serious eye exposure can result in blindness. If sodium
hydroxide mist was breathed, permanent injury to the lungs
may result. If a solution was swallowed, damage to the mouth,
throat, and esophagus may cause permanent scarring, making
swallowing difficult.
What tests can be done if a person has been exposed to sodium hydroxide?
Specific tests for the presence of sodium
hydroxide in blood or urine are not available. If a severe
exposure has occurred, blood and urine analyses and other
tests may show whether the lungs, eyes, or stomach has been
injured. Testing is not needed in every case.
Where can more information about sodium hydroxide be found?
More information about sodium hydroxide
can be obtained from your regional poison control center;
your state, county, or local health department; the Agency
for Toxic Substances and Disease Registry (ATSDR); your doctor;
or a clinic in your area that specializes in occupational
and environmental health. If the exposure happened at work,
you may wish to discuss it with your employer, the Occupational
Safety and Health Administration (OSHA), or the National Institute
for Occupational Safety and Health (NIOSH). Ask the person
who gave you this form for help in locating these telephone
numbers.
Follow-up Instructions
Keep this page and take it with you to
your next appointment. Follow only the instructions
checked below.
Print instructions only.pdf icon[46.4 KB]
[ ] Call your doctor or the Emergency
Department if you develop any unusual signs or symptoms within
the next 24 hours, especially:
- drooling or difficulty swallowing
- stomach pain or vomiting
- coughing, wheezing, or hoarseness
- difficulty breathing, shortness of breath, or chest pain
- increased pain or a discharge from exposed eyes
- increased redness or pain or a pus-like discharge in the
area of a skin burn
[ ] No follow-up appointment is necessary
unless you develop any of the symptoms listed above.
[ ] Call for an appointment with Dr.____
in the practice of ________.
When you call for your appointment, please
say that you were treated in the Emergency Department at _________
Hospital by________and were advised to be seen again in ____days.
[ ] Return to the Emergency Department/Clinic
on ____ (date) at _____ AM/PM for a follow-up examination.
[ ] Do not perform vigorous physical
activities for 1 to 2 days.
[ ] You may resume everyday activities
including driving and operating machinery.
[ ] Do not return to work for _____days.
[ ] You may return to work on a limited
basis. See instructions below.
[ ] Avoid exposure to cigarette smoke
for 72 hours; smoke may worsen the condition of your lungs.
[ ] Avoid drinking alcoholic beverages
for at least 24 hours; alcohol may worsen injury to your stomach
or have other effects.
[ ] Avoid taking the following medications:
________________
[ ] You may continue taking the following
medication(s) that your doctor(s) prescribed for you: _______________________________
[ ] Other instructions:
____________________________________
_____________________________________________________
- Provide the Emergency Department with the name and the
number of your primary care physician so that the ED can
send him or her a record of your emergency department visit.
- You or your physician can get more information on the
chemical by contacting: ____________ or _____________, or by
checking out the following Internet Web sites:
___________;__________.
Signature of patient _______________ Date ____________
Signature of physician _____________ Date ____________
Where can I get more information?
If you have questions or concerns, please contact your community or state health or environmental quality department or:
For more information, contact:
Agency for Toxic Substances and Disease Registry
Division of Toxicology and Human Health Sciences
4770 Buford Highway
Chamblee, GA 30341-3717
Phone: 1-800-CDC-INFO 888-232-6348 (TTY)
Email: Contact CDC-INFO
ATSDR can also tell you the location of occupational and environmental health clinics. These clinics specialize in recognizing, evaluating, and treating illnesses resulting from exposure to hazardous substances.