II. Mechanism
- Significantly acidic (pH <5) or significantly basic (ph>9) ingestion
- Alkali are more common in the U.S. (and more destructive)
- Internationally, strong acids (e.g. Hydrochloric Acid, Sulfuric Acid) are also readily available
III. Precautions
- Mouth lesions from ingestion do not correlate well with gastrointestinal lesions
- Intentional ingestion is associated with larger quantity ingestion (higher risk)
IV. Management
- ABC Management
- Have a low threshold to observe or admit patients even with only mild symptoms (esp. intentional ingestion)
- Consult poison control
- Significant chest or Abdominal Pain
- Consider CT Chest and CT Abdomen and Pelvis
- Consider gastroenterology or surgery for upper endoscopy within first 12-24 hours
- Endoscopy-related perforation risk increases after the first 24 hours
- Other measures
- Administer intravenous Proton Pump Inhibitor (e.g. IV Protonix) or H2 Blocker (e.g. IV Pepcid)
- Antibiotics are indicated for peritoneal signs
- Exercise caution with Nasogastric Tube placement
- Safest to place under direct visualization during endoscopy (to prevent perforation)
- Decision to use Corticosteroids is based on upper endoscopy findings (do not give empirically)
- Typically used in burns encompassing >75% of esophageal circumference (2B burn)
- Corticosteroids may prevent Esophageal Strictures
V. Complications
VI. References
- Claudius and Levine in Herbert (2019) EM:Rap 19(3): 4-5