What is the treatment for plaster of Paris ingestion?

Treatment of Plaster of Paris Ingestion

Activated charcoal should be administered as soon as possible after plaster of Paris ingestion, ideally within 1-4 hours, at a standard dose of 1g/kg orally in a slurry form. 1

Initial Management

• Contact Poison Control Center (800-222-1222 in the US) immediately for guidance specific to the case 2
• Assess for signs of life-threatening conditions such as sleepiness, seizures, difficulty breathing, or vomiting, which would require immediate EMS activation 2
• Perform radiographic imaging (plain radiographs of neck, chest, and abdomen) to assess the presence, location, and size of the ingested plaster of Paris 1
• Consider CT scan if there is suspicion of perforation or other complications that may require intervention 1

Decontamination Approach

• Administer activated charcoal (1g/kg orally in a slurry) as the primary decontamination method 1
• Activated charcoal is most effective if given within one hour of ingestion but may be beneficial up to 3-4 hours after ingestion 1, 3
• Do not administer milk or water for dilution as there is insufficient evidence of benefit and possible adverse effects including emesis and aspiration 2
• Do not induce vomiting with ipecac as it has no clinically relevant advantage and may cause intractable emesis and delayed care 2

Special Considerations

• For complete esophageal obstruction, emergent endoscopic removal may be necessary 1
• Monitor for signs of perforation, which include fever, subcutaneous emphysema, erythema, and tenderness 4
• Surgical intervention should be considered if:
  • The plaster of Paris cannot be retrieved endoscopically 1
  • Perforation has occurred 1
  • Other complications have developed 1

Supportive Care

• Monitor the patient for at least 24-48 hours after successful removal of the plaster of Paris 1
• Provide supportive care including fluid resuscitation if needed 2
• Assess for chemical burns or irritation to the gastrointestinal tract 2
• Patients with minimal or no injuries can be fed immediately and discharged quickly after observation 1

Efficacy of Activated Charcoal

• Activated charcoal has the ability to adsorb a wide variety of substances and prevent gastrointestinal absorption 5
• It is generally more effective than gastric emptying for most toxins 5
• Multiple doses of activated charcoal may be beneficial for certain toxins that undergo enterohepatic circulation, though this is not typically necessary for plaster of Paris 6

Contraindications to Activated Charcoal

• Do not administer activated charcoal if:
  • The airway is not protected in an obtunded patient 7
  • There is known or suspected gastrointestinal perforation 7
  • The ingested substance is caustic (strong acid or alkali) 5

While the evidence specifically for plaster of Paris ingestion is limited, the general principles of toxicology management apply, with activated charcoal being the cornerstone of treatment when administered promptly after ingestion 1, 3.