Caustic ingestion - Revision history

Danbot: Add peer-reviewed references with PMIDs

2026-03-22T09:59:07Z

Add peer-reviewed references with PMIDs

← Older revision		Revision as of 09:59, 22 March 2026
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	**May infiltrate damaged mucosa & interfere with EGD		**May infiltrate damaged mucosa & interfere with EGD
	**Only consider when coingestants pose a risk for severe systemic toxicity		**Only consider when coingestants pose a risk for severe systemic toxicity
	**Zinc chloride and mercuric chloride systemic absorptions may outweigh interference with endoscopy		**Zinc chloride and mercuric chloride systemic absorptions may outweigh interference with endoscopy<ref>Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol. 2013;19(25):3918-3930. PMID 23840136</ref>
	*[[Special:MyLanguage/Gastric lavage\|Gastric lavage]]		*[[Special:MyLanguage/Gastric lavage\|Gastric lavage]]
	**Contraindicated due to potential to cause reflux of caustic agent into esophagus, creating more damage		**Contraindicated due to potential to cause reflux of caustic agent into esophagus, creating more damage

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2026-01-07T12:28:51Z

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2026-01-04T21:47:01Z

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Rossdonaldson1: /* Background */

2024-02-07T22:34:36Z

Background

← Older revision		Revision as of 22:34, 7 February 2024
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	==Background==		==Background==
			[[File:Gray1032.png\|thumb\|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]
			[[File:Layers of the GI Tract english.svg\|thumb\|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]]
			[[File:Illu esophagus.jpg\|thumb\|Esophagus anatomy and nomenclature based on two systems.]]
	{{Caustics background}}		{{Caustics background}}

Elcatracho: /* Clinical Features */

2021-02-11T23:49:40Z

Clinical Features

← Older revision		Revision as of 23:49, 11 February 2021
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	**[[Dysphagia]], odynophagia, drooling, [[epigastric pain]], [[vomiting]]		**[[Dysphagia]], odynophagia, drooling, [[epigastric pain]], [[vomiting]]
	*Laryngotracheal injury		*Laryngotracheal injury
	**Dysphonia, [[stridor]], [[respiratory distress]]		**[[Dysphonia]], [[stridor]], [[respiratory distress]]
	**Occurs via aspiration of caustic or vomitus or inhalation of acidic fumes		**Occurs via aspiration of caustic or vomitus or inhalation of acidic fumes

Hoxbox: /* Disposition */

2020-10-02T11:06:47Z

Disposition

← Older revision		Revision as of 11:06, 2 October 2020
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	*All patients with symptoms from a caustic ingestion should be admitted for at least 24 hours of observation		*All patients with symptoms from a caustic ingestion should be admitted for at least 24 hours of observation
	*All patients with intentional ingestion should be evaluated by psych prior to discharge		*All patients with intentional ingestion should be evaluated by psych prior to discharge
			[[File:Ingestion.png\|thumb]]

	===Prognosis===		===Prognosis===

Cdichang: /* Disposition */

2020-05-15T02:02:02Z

Disposition

← Older revision		Revision as of 02:02, 15 May 2020
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	==Disposition==		==Disposition==
	*All patients with symptoms from a caustic ingestion should be admitted		*All patients with symptoms from a caustic ingestion should be admitted for at least 24 hours of observation
	*All patients with intentional ingestion should be evaluated by psych prior to discharge		*All patients with intentional ingestion should be evaluated by psych prior to discharge

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	*Depending on severity may have full return of mobility and function or can progress to perforation followed by stricture formation		*Depending on severity may have full return of mobility and function or can progress to perforation followed by stricture formation
	*'''Days 2-14''' post-injury are associated with highest tissue friability / risk of perforation		*'''Days 2-14''' post-injury are associated with highest tissue friability / risk of perforation
	*High-grade caustic burns associated with 1000x increase in esophageal ~~SCC~~		*Strictures typically develop in the first 2 months, higher risk in those with circumferential esophageal erosions (Grade 2B burns and above)
			*High-grade caustic burns associated with 1000x increase in esophageal adenocarcinoma or squamous-cell carcinoma

	==See Also==		==See Also==

Cdichang: /* Management */

2020-05-15T01:59:42Z

Management

← Older revision		Revision as of 01:59, 15 May 2020
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	==Management==		==Management==
	*Prevent provider and continued patient exposure to the caustic agent by removing all clothing and decontaminating the patient		*Prevent provider and continued patient exposure to the caustic agent by removing all clothing and decontaminating the patient
	*No strong evidence in using activated charcoal, blind nasogastric-tube insertion for irrigation (can cause thermal injury through neutralization)
	*There is a possible benefit of water ingestion immediately after ingestion of a powdered caustic to irrigate adherent materials in oropharynx/esophagus if no airway concerns to prevent prolonged injury from the powder adhering to tissues<ref>Hoffman et al. Ingestion of Caustic Substances. N Engl J Med. 2020. Apr;382(18):1739-1748</ref>		*There is a possible benefit of water ingestion immediately after ingestion of a powdered caustic to irrigate adherent materials in oropharynx/esophagus if no airway concerns to prevent prolonged injury from the powder adhering to tissues<ref>Hoffman et al. Ingestion of Caustic Substances. N Engl J Med. 2020. Apr;382(18):1739-1748</ref>

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	*[[Gastric lavage]]		*[[Gastric lavage]]
	**Contraindicated due to potential to cause reflux of caustic agent into esophagus, creating more damage		**Contraindicated due to potential to cause reflux of caustic agent into esophagus, creating more damage
			**Blind nasogastric-tube insertion for irrigation can cause thermal injury through neutralization
	*Dilution with water or milk causes vomiting, elevating risk for perforation		*Dilution with water or milk causes vomiting, elevating risk for perforation
	**Possible benefit only for solid alkali ingestions		**Possible benefit only for solid alkali ingestions

Cdichang: /* Endoscopy */

2020-05-15T01:56:48Z

Endoscopy

← Older revision		Revision as of 01:56, 15 May 2020
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	===Endoscopy===		===Endoscopy===
	Should be performed ~~within 12-~~24 hours of ingestion (too early can underestimate extent of injury, too late increases risk of wound softening and perforation).		Should be performed in the first 24 to 48 hours after ingestion (too early can underestimate extent of injury, too late increases risk of wound softening and perforation).

	;Indications:		;Indications:

Cdichang: /* Esophageal Stricture MitigationHigh Doses of Methylprednisolone in the Management of Caustic Esophageal Burns. Pediatrics 2014;133:e1518–e1524 */

2020-05-15T01:54:55Z

Esophageal Stricture MitigationHigh Doses of Methylprednisolone in the Management of Caustic Esophageal Burns. Pediatrics 2014;133:e1518–e1524

← Older revision		Revision as of 01:54, 15 May 2020
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	**[[Ceftriaxone]]		**[[Ceftriaxone]]
	**Total parenteral nutrition		**Total parenteral nutrition
			*Sucralfate, Mitomycin C

	===Surgical Intervention===		===Surgical Intervention===