What is the treatment for gypsum ingestion?

Treatment for Gypsum Ingestion

The primary treatment for gypsum ingestion is administration of activated charcoal as soon as possible, ideally within 1-4 hours of ingestion, at a standard dose of 1g/kg orally in a slurry form. 1

Initial Management

• Activated charcoal is most effective if given within the first hour but may provide benefit up to 3-4 hours after ingestion 1
• Assess immediately for signs of complete esophageal obstruction, which would require more urgent intervention 1
• Ensure adequate fluid intake, as insufficient fluids with similar hygroscopic substances (like psyllium) can worsen obstruction 2

Diagnostic Evaluation

• Obtain plain radiographs of neck, chest, and abdomen to assess the presence, location, size, and shape of the ingested gypsum and to look for signs of perforation 1
• Perform CT scan if there is suspicion of perforation or other complications that may require interventional endoscopy or surgery 1
• Be vigilant for symptoms such as:
  • Dysphagia or complete inability to swallow 3
  • Chest pain and breathing difficulties 4
  • Abdominal distension or pain 2

Interventional Management

• Therapeutic flexible endoscopy is recommended as first-line treatment if the gypsum has caused persistent esophageal obstruction 1
• Emergent endoscopy is indicated if the ingested gypsum is causing complete esophageal obstruction 1
• Surgical intervention should be considered if:
  • The gypsum cannot be retrieved endoscopically 1
  • Perforation has occurred 1
  • Complications have developed 1

Follow-up Care

• Monitor patients for at least 24-48 hours after successful removal of the gypsum 1
• Patients with Grade I injuries can be fed immediately and discharged quickly after observation 1
• Consider psychiatric evaluation in cases of intentional ingestion 1

Important Caveats

• Do not assume the severity of injury based on symptoms alone - the absence of severe oral burns or pharyngoesophageal symptoms does not exclude esophageal or gastric injury 5
• Patients with pre-existing conditions affecting esophageal motility (such as Parkinson's disease) may be at higher risk for complications due to increased esophageal transit time 3
• Bezoar formation is a potential complication that may require endoscopic removal, especially if the gypsum forms a hardened mass in the gastrointestinal tract 3