Role of Antacids in Corrosive Poisoning
Antacids and neutralization agents should NOT be administered in corrosive poisoning, as they are contraindicated and provide no clinical benefit while potentially causing harm through exothermic reactions and increased tissue injury. 1, 2, 3
Why Neutralization is Contraindicated
The fundamental principle in corrosive poisoning management is to avoid any attempt at chemical neutralization:
Neutralization reactions generate heat that causes additional thermal injury to already damaged tissues, worsening the extent of corrosive burns 3, 4
No evidence supports benefit: There are no human studies demonstrating that neutralization with antacids, acids, or any other agents improves outcomes in corrosive ingestions 1
Basic therapeutic principles explicitly contraindicate corrosive substance neutralization as a management strategy 3
What About Dilution?
The evidence on dilution (water or milk) is limited but distinct from neutralization:
Insufficient evidence exists for or against administering water or milk as a diluent in the first aid setting 1
Animal studies suggest potential benefit from dilution when administered following alkali or acid exposure, but no human studies demonstrate clinical improvement 1, 2
If dilution is attempted, it must be done within the first 60 minutes after ingestion with plain water or milk—not antacids or neutralizing agents 3
The American Heart Association recommends against administering anything by mouth (including water, milk, or activated charcoal) unless specifically directed by poison control, due to risk of emesis and aspiration 2
Correct Management Approach
Instead of antacids or neutralization, focus on:
Immediate stabilization of airway, breathing, and circulation 5
Contact Poison Control Center immediately for guidance on systemic toxicity management 5, 2
Early endoscopy (within 12-24 hours) to assess extent of injury—this is the gold standard for determining grade and extent of lesions 3, 4, 6
Supportive care including NPO status, fluid/electrolyte management, antibiotics, anti-secretory therapy, and nutritional support 3, 4
Surgical consultation if signs of perforation, extensive necrosis, or severe bleeding develop 5
Critical Pitfalls to Avoid
Never induce vomiting with ipecac or any other method—this is explicitly contraindicated and causes harm 1, 2, 3
Never perform gastric lavage if corrosive injury is suspected, as it increases perforation risk 5, 3
Activated charcoal has no effect in corrosive poisonings and is not indicated 3
Do not delay endoscopic evaluation, as initial symptoms may not correlate with extent of damage 5