Chemical epiglottitis causing airway compromise after benzalkonium chloride ingestion.

Introduction: Benzalkonium chloride, a quaternary ammonium compound with disinfectant properties, produces caustic effects at concentrations of 0.1% or higher. However, the relationship between the characteristics of the ingested substance and clinical severity, including airway compromise, is not always straightforward.

Case summary: A 77-year-old man presented with odynophagia and drooling after accidentally ingesting only 1 mL of 10% benzalkonium chloride and 1% isopropyl methyl phenol (Neotraban Green^®). Given the risk of airway compromise, emergency endotracheal intubation was performed. Despite the high concentration, no oral, esophageal, or gastric injury was observed.

Images: Flexible laryngoscopy revealed marked epiglottic and arytenoid swelling, leading to a diagnosis of chemical epiglottitis.

Conclusion: Even minimal ingestion of high-concentration benzalkonium chloride can cause life-threatening upper airway injury. Clinicians should maintain a high index of suspicion for airway compromise in cases of caustic ingestion based not only on ingested volume but also on clinical signs.