What are the recommended treatments for managing acid consumption?

Management of Acid Ingestion (Caustic Injury)

For acute acid ingestion, immediately contact Poison Control, avoid inducing vomiting or neutralization attempts, and perform urgent esophagogastroduodenoscopy (EGD) within 12-24 hours to assess injury severity and guide management. 1

Immediate Assessment and Stabilization

Critical initial steps:

• Identify the specific acid ingested, physical form (liquid vs solid), quantity consumed, and whether ingestion was intentional or accidental, as these factors determine injury severity 1

• Contact Poison Control Centers immediately to evaluate potential systemic toxicity of the ingested agent 1

• Obtain initial laboratory evaluation including renal function tests (urea and creatinine) to assess injury severity 1

• Perform β-HCG in women of childbearing age to rule out pregnancy 1

Critical pitfall: Do NOT induce vomiting, attempt neutralization with alkaline substances, or administer activated charcoal—these interventions can worsen tissue injury 1

Diagnostic Evaluation

EGD is the gold standard for determining presence and severity of corrosive esophageal and gastric lesions and should be performed urgently (within 12-24 hours of ingestion). 1

• Laboratory abnormalities including deranged liver function tests and elevated CRP may indicate transmural necrosis and need for surgical intervention 1

• Strong acids can induce extensive necrosis of the gastrointestinal tract, particularly with massive ingestion 1

Treatment Approach Based on Injury Severity

For Mild to Moderate Injuries (No Perforation):

• Initiate aggressive acid suppression with proton pump inhibitors (PPIs), optimizing timing of dose and considering dose escalation if needed 1

• Consider switching to a different PPI if response is inadequate 1

• Add H2-receptor antagonists for nocturnal symptoms as adjunctive therapy 1

For Severe Injuries:

• Patients with severe injuries require indefinite long-term PPI therapy similar to severe GERD management 1

• Surgical intervention is required for esophageal or gastric perforation 1

• Consider early surgical consultation for patients with evidence of transmural necrosis (elevated CRP, deranged liver function tests) 1

Long-Term Management

For patients who survive the acute injury and develop chronic strictures or GERD-like symptoms:

• Continue long-term PPI therapy indefinitely, similar to management of severe erosive esophagitis 2

• Monitor for stricture formation requiring endoscopic dilation 1

• Assess for Barrett's esophagus development in long-term follow-up, which would mandate continued PPI therapy 2