Toxin

Caustic Ingestion

Caustic Ingestion, Acid Ingestion, Base Ingestion, Alkali Ingestion, Poisoning by Alkalinizing Agent, Ingestion of Corrosive Chemical

Significantly acidic (pH <5) or significantly basic (ph>9) ingestion
1. Alkali are more common in the U.S. (and more destructive)
2. Internationally, strong acids (e.g. Hydrochloric Acid, Sulfuric Acid) are also readily available

Mouth lesions from ingestion do not correlate well with gastrointestinal lesions
Intentional ingestion is associated with larger quantity ingestion (higher risk)

ABC Management
1. Be prepared to intubate for Stridor, Drooling, respiratory distress
Have a low threshold to observe or admit patients even with only mild symptoms (esp. intentional ingestion)
1. Consult poison control
Significant chest or Abdominal Pain
1. Consider CT Chest and CT Abdomen and Pelvis
2. Consider gastroenterology or surgery for upper endoscopy within first 12-24 hours
  1. Endoscopy-related perforation risk increases after the first 24 hours
Other measures
1. Administer intravenous Proton Pump Inhibitor (e.g. IV Protonix) or H2 Blocker (e.g. IV Pepcid)
2. Antibiotics are indicated for peritoneal signs
3. Exercise caution with Nasogastric Tube placement
  1. Safest to place under direct visualization during endoscopy (to prevent perforation)
4. Decision to use Corticosteroids is based on upper endoscopy findings (do not give empirically)
  1. Typically used in burns encompassing >75% of esophageal circumference (2B burn)
  2. Corticosteroids may prevent Esophageal Strictures