title: The emergency management of caustic ingestions.
abstract: In the emergency department, any patient who is suspected of having sustained a caustic ingestion must be handled in a serious manner. All patients should be initially stabilized with regard to airway and circulatory status. Initial questioning concerning the type and quantity of agent ingested will be most helpful. Signs and symptoms of shock, impending perforation, or airway distress take precedence over any further work-up. Patients who have a known history of ingestion require admission to the hospital. Complete physical examination should be carried out, bearing in mind that the lack of oropharyngeal involvement or other symptoms does not rule out the possibility of esophageal burns. One should avoid emesis and should begin early dilutional therapy. Water may be used initially to dislodge adherent solid particles, as well as to dilute the caustic ingestion. It is important not to be excessively aggressive with dilution, as this may cause nausea, vomiting, and possible aspiration. Early otolaryngologic evaluation will be most helpful. The role of early esophagoscopy has been demonstrated to aid greatly in determining the further management. This diagnostic procedure should be carried out within 48 hours after ingestion. Based on the information obtained with esophagoscopy, patients who have had moderate esophageal burns should receive 20 mg methylprednisone intravenously every eight hours if under the age of two and 40 mg intravenously every eight hours if over the age of two. When oral preparations can be used, 2 mg per kg of prednisone should be continued for three to four weeks. Antibiotic coverage should be reserved until the first sign of infection occurs.
mesh_terms: D000143:Acids / Q000506:poisoning; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002057:Burns, Chemical / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D002424:Caustics / Q000506:poisoning*; D002675:Child, Preschool; D004630:Emergencies; D004639:Emetics / Q000009:adverse effects; D004945:Esophagoscopy; D004947:Esophagus / Q000293:injuries / Q000601:surgery; D005743:Gastrectomy; D005751:Gastric Lavage; D049673:History, 20th Century; D006795:Household Products / Q000266:history / Q000506:poisoning*; D006801:Humans; D007013:Hypopharynx / Q000293:injuries; D007441:Intubation, Gastrointestinal; D008046:Lip / Q000293:injuries; D009055:Mouth / Q000293:injuries; D009336:Necrosis / Q000139:chemically induced
chemical_list: D000143:Acids; D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D002424:Caustics; D004639:Emetics