What is the treatment for gypsum ingestion?

Treatment for Gypsum Ingestion

For gypsum ingestion, immediate administration of activated charcoal (1g/kg orally) is recommended as the first-line treatment to prevent absorption, followed by supportive care and monitoring for complications.

Initial Management

• Activated charcoal should be administered as soon as possible after ingestion (ideally within 1-4 hours) at a standard dose of 1g/kg orally in a slurry form 1
• Gastrointestinal decontamination with activated charcoal is most effective if given within the first hour of ingestion but may be of benefit up to 3-4 hours after ingestion 1
• Assess for signs of complete esophageal obstruction (inability to swallow saliva, drooling) which would require more urgent intervention 1

Diagnostic Evaluation

• Plain radiographs of neck, chest, and abdomen should be obtained to assess the presence, location, size, and shape of the ingested gypsum and to look for signs of perforation 1
• CT scan should be performed if there is suspicion of perforation or other complications that may require interventional endoscopy or surgery 1
• Contrast studies are not recommended as they may coat the foreign body and esophageal mucosa, impairing subsequent endoscopic visualization 1

Endoscopic Management

• Therapeutic flexible endoscopy is recommended as first-line treatment if the gypsum has caused persistent esophageal obstruction 1
• Emergent endoscopy (within 2-6 hours) is indicated if the ingested gypsum is causing complete esophageal obstruction 1
• Urgent endoscopy (within 24 hours) is recommended for esophageal foreign bodies without complete obstruction 1
• Retrieval techniques using baskets, snares, and grasping forceps should be considered for removal of the gypsum material 1

Special Considerations for Gypsum

• Gypsum has hygroscopic properties similar to psyllium, which can expand when in contact with fluids, potentially causing obstruction 2, 3
• Ensure adequate hydration to prevent the gypsum from hardening and forming a bezoar in the gastrointestinal tract 2
• Monitor for symptoms of intestinal obstruction such as abdominal distension, constipation, and abdominal pain 2

Surgical Management

• Surgery should be considered if:
  • The gypsum cannot be retrieved endoscopically 1
  • Perforation has occurred 1
  • The foreign body is close to vital structures (e.g., aortic arch) 1
  • Complications such as mediastinitis, pleural empyema, or fistula have developed 1
• The surgical approach depends on the location of impaction, with minimally invasive techniques being the first-line treatment in referral centers 1

Complications to Monitor

• Esophageal or gastric perforation 1
• Bezoar formation leading to obstruction 2, 3
• Respiratory symptoms if aspiration has occurred 1
• Long-term complications such as stricture formation 4

Follow-up Care

• Patients should be monitored for at least 24-48 hours after successful removal of the gypsum 1
• Those with Grade I injuries (minimal mucosal damage) can be fed immediately and discharged quickly 1
• Patients with more severe injuries may require longer observation and nutritional support 1
• Psychiatric evaluation should be considered in cases of intentional ingestion 1