injuries poisoning
Caustic Ingestion
Treatment of Caustic Ingestion
Avoidance of gastric emptying Sometimes dilution with oral fluids In general, acid and alkali ingestions are treated similarly, with supportive care. (CAUTION:Gastric emptying by emesis or lavage is contraindicated because it can reexpose the upper gastrointestinal tract to the caustic. Attempts to neutralize a caustic acid by correcting pH with an alkaline substance [and vice versa] are contraindicated because severe exothermic reactions may result. Activatedcharcoalis contraindicated because it may infiltrate burned tissue and interfere with endoscopic evaluation, and insertion of a nasogastric tube is contraindicated because it can damage already compromised mucosal surfaces.) Do not do gastric emptying by emesis or lavage with a caustic ingestion because it reexposes the upper gastrointestinal tract to the caustic. Do not attempt to neutralize a caustic acid with an alkaline substance (and vice versa) because it will produce heat that may worsen tissue damage. Dilution with milk or water is only useful in the first few minutes after ingesting a liquid caustic, but delayed dilution may be useful after ingesting a solid caustic. Dilution should be avoided if patients have nausea, drooling, stridor, or abdominal distention. Esophageal or gastric perforation is treated with antibiotics and surgery (see Acute Perforation of the Gastrointestinal Tract ). IV corticosteroids and prophylactic antibiotics are not recommended. Strictures are treated with bougienage or, if they are severe or unresponsive, with esophageal bypass by colonic interposition. 