Introduction
As I course through the alimentary canal, hitting retained foreign bodies last week, today it’s caustic ingestions, pearls and myths.
Disclaimers
These are general emergency situation guidelines that physicians adhere to. They are certainly not the recommendations for how you should manage a friend or yourself if you feel you have ingested some toxic agent inadvertently.
What to do When Your Loved One Ingests Poison
If you suspect a caustic ingestion, take your loved one to the emergency room immediately, cracking the windows on your car to simulate blow by oxygen. Or call 911.
Discussion
Caustic ingestions. Some famous myths that lead to big misses that I will settle for you at this time. If the ingestion is an acid, then it is worse for, what? Your stomach or your esophagus?
This confuses a lot of people because they think the stomach can tolerate acid. It’s stomach. A caustic indigestion of the acidic type is worse for the stomach then it is for the esophagus. Because the stomach is a pouch, the acidic caustic agent, whatever it may be, pools as it sits around there for a while. Thus, it causes more tissue damage when it is retained there in this bag until passing on through.
Does Acidic Caustic Ingestion Harm the Esophagus?
The esophagus? Does it tolerate acidic caustic ingestions well or better than the stomach? It’s quite acid resilient turns out, if it’s presence there is transient — as is usually the case of course because, with gravity, the ingestion goes straight down, and doesn’t hang around in the esophagus very long. But of course if the patient is lying down because they are subconscious for whatever reason, it will damage the esophagus more of course. But in those situations you are going to more detective type stories. Nobody likes lying down after a caustic ingestion. They run towards the emergency room.
And what if the caustic ingestion is alkali? Well, that is definitely worse for esophagus than it is for the stomach. Alkaline caustic ingestions cause liquefaction of the very intolerant esophagus, no matter how transient the passage of the caustic substance. Liquefaction necrosis is what alkaline ingestions cause to the esophagus. It even sounds bad.
So that busted a few myths if not minutes for you. Now what about some classic pearls about what NOT to do for foreign bodies and caustic congestions.
What to Do and Not Do When Caustic Ingestion Occurs
Here we go. So, FB or caustic ingestions. What about meat tenderizer? It was always generally suspected that meat tenderizer would break up a foreign body especially if it was food and that it might soften up the esophagus for easier passage if it’s not food. Completely wrong. Meat tenderizers are very dangerous in all foreign body and caustic ingestions.
So… Nope.
What about neutralizers? It was always suspected that if you had ingested an acid, to put in something alkaline; and, similarly, if you ingest it an alkali, put in some acid. Completely wrong on both counts for similar reasons. The chemical reactions produced are almost always exothermic — it means producing heat. So you are adding a heat reaction and heat to the caustic ingestion’s damage. Great. Not.
So… Nope.
How about inducing nausea and vomiting? Shouldn’t those be induced? Absolutely not. If passage of such a caustic substance was bad going one way, it’s most definitely the wrongest thing you can do to have it pass through that tissue a second time.
So… Nope.
What about charcoal? Wrong again. That is falling into disfavor. It turns out it doesn’t really absorb very much of the caustic substance at all.
Here’s a trick question. What about blind nasotracheal intubation? You know, just quickly save the person’s life.
Absolutely not indicated. So… Nope. Hopefully I didn’t trick you.
Lastly, And here’s a big one. Antibiotics? Isn’t that a good idea for caustic ingestions or foreign body ingestions?
The answer is again no. Unless there is some sort of perforation that can be documented based on imaging or clinical course, empiric use of antibiotics in the setting of caustic ingestions and foreign bodies is no longer indicated.
Caustic Ingestion Treatment
Conclusion
- Caustic ingestions: acid worse for stomach (pools; esophagus acid resilient if transient); alkali worse for esophagus (Liquefaction necrosis).
- FB or caustic ingestions ->No meat tenderizer, neutralizers, N/V, charcoal, blind NT intubation, or ABX (unless perforation).
Caustic ingestions. They can be quite costly. Sorry, with no tremendous pneumonics to offer today, I close with a seriously bad pun.
