What to give after hydrochloric acid (HCl) ingestion?

Management of Hydrochloric Acid Ingestion

Do not administer anything by mouth for hydrochloric acid ingestion unless specifically advised to do so by a poison control center or emergency medical personnel, as it may cause further harm. 1

Initial Emergency Management

• Immediately activate emergency medical services (EMS) if the patient shows any signs of life-threatening conditions such as respiratory distress, vomiting, or altered mental status 1
• Contact the Poison Help hotline (800-222-1222 in the US) for expert guidance on management of hydrochloric acid ingestion 1
• Remove any remaining acid from the oral cavity and remove contaminated clothing around the mouth and face area to prevent further exposure 2
• Do not induce vomiting as it can cause re-exposure of the esophagus to the acid and increase risk of aspiration 2

What NOT to Do

• Do not administer water or milk for dilution without specific medical advice, as there is insufficient evidence supporting this practice and possible adverse effects include emesis and aspiration 1, 2
• Do not administer activated charcoal as it is ineffective for caustic substances and may obscure subsequent endoscopic evaluation 1, 2
• Do not administer syrup of ipecac as it can cause intractable emesis and delay care in an advanced medical facility 1

Medical Facility Management

• Perform immediate assessment of airway status as acid ingestion can cause severe upper airway obstruction requiring endotracheal intubation 3
• Conduct emergency contrast-enhanced CT examination 3-6 hours after ingestion to detect transmural injuries 2
• Perform upper gastrointestinal endoscopy within 12-48 hours to determine prognosis and guide management 2
• Laboratory evaluation should include complete blood count, electrolytes, liver function tests, pH, and serum lactate to identify potential systemic effects 2

Treatment Based on Injury Severity

• For skin or eye exposure to acid, immediately irrigate the affected area with copious amounts of water 1
• For severe metabolic acidosis from acid ingestion, sodium bicarbonate may be administered (1-2 mEq/kg IV) after effective ventilation has been established 1
• For patients with evidence of transmural necrosis, emergency surgery should be considered as it may be lifesaving 2, 4
• For patients without full-thickness necrosis, non-operative management with close clinical monitoring may be offered 2

Complications and Prognosis

• Hydrochloric acid ingestion can cause severe caustic injury with high mortality rates (up to 48% in some studies), particularly when necrosis extends to the duodenopancreatic region 5, 4
• Gastric perforation is a potential complication requiring emergency surgery 6
• Long-term complications may include stricture formation requiring endoscopic dilation, though this should be avoided within 3 weeks of initial ingestion due to higher risk of complications 2

Important Caveats

• Clinical symptoms do not always correlate with the extent of gastrointestinal damage, with absence of pain and oral lesions not ruling out serious injuries 2
• Acids cause coagulative necrosis forming an eschar that may limit penetration, but tend to cause more severe gastric injury than esophageal injury due to rapid transit through the esophagus and pooling in the stomach 2
• The physical form of the ingested substance affects the pattern of injury, with liquids causing burns of the esophagus and stomach 2