Management Guidelines for Corrosive Poisoning
Emergency management of corrosive poisoning should focus on immediate assessment, avoiding neutralization attempts, and early endoscopic evaluation to determine injury severity and guide treatment decisions. 1, 2
Initial Management
Immediate Stabilization
- Secure airway, breathing, and circulation
- Assess for signs of perforation (abdominal pain, peritoneal signs, pneumomediastinum)
- Do NOT induce vomiting, perform gastric lavage, or attempt neutralization 3
- Do NOT administer activated charcoal (ineffective for corrosives) 3
- Dilution with water or milk may be considered only within 60 minutes of ingestion 3
Laboratory Evaluation
- Complete blood count, electrolytes, renal function, liver function tests
- Arterial blood gas to assess acid-base status
- Monitor for signs of systemic toxicity:
- Hypocalcemia (with phosphoric/hydrofluoric acids)
- Hyponatremia (strong acids/alkalis)
- Hypokalemia and metabolic acidosis 1
Imaging
- Chest and abdominal radiographs to assess for free air (perforation) 1
- Contrast-enhanced CT scan 3-6 hours post-ingestion is recommended to assess extent of injury and detect transmural necrosis (absence of wall enhancement) 2
Endoscopic Evaluation
- Esophagogastroduodenoscopy within 12-24 hours is the gold standard for assessing injury severity 4
- Zargar classification for endoscopic grading:
- Grade I: Superficial damage (epithelial desquamation, mucosal edema)
- Grade IIA: Transmucous damage without necrosis
- Grade IIB: Transmucous damage with necrosis
- Grade III: Transmural damage with potential perforation 5
Treatment Based on Injury Severity
Mild Injury (Grade I)
- Supportive care
- Oral nutrition can be introduced once pain diminishes and swallowing is possible 2
- Close monitoring for clinical deterioration
Moderate Injury (Grade IIA/IIB)
- NPO (nothing by mouth) initially
- IV fluids and nutritional support
- Consider proton pump inhibitors to reduce acid secretion
- Antibiotics if signs of infection
- Close monitoring with repeat endoscopy or CT if clinical deterioration 2
Severe Injury (Grade III)
- Immediate surgical intervention for transmural necrosis
- Total gastrectomy with preservation of native esophagus when necrosis is confined to stomach
- Esophagojejunostomy reconstruction with feeding jejunostomy placement
- Partial gastric resections are not recommended due to risk of ongoing necrosis 2
- Careful inspection of adjacent organs for concomitant necrosis 2
Prevention and Management of Complications
Stricture Prevention and Management
- Follow-up endoscopy 4-6 months post-ingestion 2
- Endoscopic dilation can begin 3-6 weeks after injury healing
- Typical dilation schedule: 1-3 week intervals, with 3-5 sessions usually required
- Graded approach to dilation (13-20mm) with fluoroscopic guidance for complex strictures 2
Long-term Follow-up
- Regular endoscopic surveillance due to increased risk of esophageal carcinoma
- Psychiatric evaluation mandatory for all patients prior to discharge, especially for intentional ingestions 2
- Nutritional support and monitoring
Special Considerations
Protective Measures for Healthcare Providers
- Wear appropriate protective clothing and gloves when handling victims
- Use masks with non-return valve systems if assisted ventilation is required
- Take precautions against direct skin contact and inhalation of toxic fumes 1
Contact with Poison Control Centers
Prognosis
- Mortality rates have decreased from 20% to 1-5% with improved management 5
- Long-term morbidity remains significant, with stenosis developing in approximately 19% of patients 6
- Patients surviving intentional corrosive poisoning require mandatory psychiatric follow-up due to high risk of subsequent suicide attempts 2