Acute effects of sucralfate aspiration: clinical and laboratory observations.
OBJECTIVE
To assess the complications associated with the aspiration of sucralfate.


METHODS
Clinical (case report) and bench observations.


METHODS
Inpatient intensive care unit and experimental animal laboratory.


METHODS
The case of a critically ill patient who aspirated sucralfate is presented. Fifteen Sprague-Dawley rats served as experimental animals to investigate the acute histologic effects of large-volume aspiration of sucralfate.


METHODS
The patient underwent emergent intubation to relieve acute upper airway obstruction. All the animals were anesthetized and had tracheostomies performed. The experimental groups had acidic intratracheal injections of 2 ml/kg of a nonparticulate liquid (pH, 2.3; n = 6) or a sucralfate aspirate (1 ml/kg of a 5% sucralfate suspension of pH 3.6, followed by 1 ml/kg 0.1 of normal hydrochloric acid of pH 1.0; n = 4). Four hours after simulated aspiration, the rats were sacrificed and their lungs removed for histologic examination by light microscopy.


RESULTS
Differences were noted in histopathologic injury in the experimental groups compared to the control group using a numeric scoring scale. Nonparticulate acidic liquid aspiration caused a significant increase (p < 0.05) in inflammation. Sucralfate caused a significant increase (p < 0.05) in lung hemorrhage. A nonsignificant trend was seen with simulated sucralfate aspiration for edema and inflammation. No long-term sequelae were attributed to the clinical aspiration episode.


CONCLUSIONS
Acute complications associated with aspiration of sucralfate have been identified. In the laboratory setting, simulated aspiration of sucralfate led to acute lung injury.
Shepherd
K E
KE
Department of Anesthesia, Massachusetts General Hospital, Boston 02114.
Faulkner
C S
CS
Leiter
J C
JC
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology; D000818:Animals; D002927:Cimetidine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D001239:Inhalation; D008168:Lung / Q000187:drug effects* / Q000473:pathology; D008171:Lung Diseases / Q000139:chemically induced; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy; D011015:Pneumonia, Aspiration / Q000139:chemically induced* / Q000473:pathology; D051381:Rats; D017207:Rats, Sprague-Dawley; D013276:Stomach Ulcer / Q000188:drug therapy; D013392:Sucralfate / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D013607:Tablets
D013607:Tablets; D013392:Sucralfate; D002927:Cimetidine