Dexamethasone in Corrosive Poisoning
Dexamethasone should NOT be given routinely in acute corrosive poisoning, but high-dose intravenous methylprednisolone (with or without dexamethasone) may be considered for persistent esophageal strictures that develop as a late complication after the acute phase has resolved. 1, 2
Acute Phase Management
The acute management of corrosive poisoning does not include corticosteroids as standard therapy. 1
Standard acute treatment consists of:
Corticosteroids are NOT part of the acute management protocol for corrosive ingestion, as the primary concern is immediate tissue damage, perforation risk, and infection prevention. 1
Late Complication Management
For persistent esophageal strictures (a late complication occurring weeks to months after injury), high-dose corticosteroids have shown benefit:
High-dose intravenous methylprednisolone protocol: 25 mg/kg/day for 4 days, then 15 mg/kg/day for 4 days, then 10 mg/kg/day for 4 days, then 5 mg/kg/day for 4 days, then 2 mg/kg/day for 4 days, administered immediately after balloon dilatation of esophageal stenosis. 2
This is followed by oral prednisolone taper: 2 mg/kg/day for 1 week, then 1 mg/kg/day for 1 week, then 0.5 mg/kg/day for 1 week. 2
Adjunctive therapy during this protocol includes: cimetidine and ampicillin for 1 week. 2
This approach has successfully resolved strictures resistant to balloon dilatation with intralesional dexamethasone injection alone, with symptom-free periods lasting 7-8 months. 2
Important Clinical Distinctions
The evidence for corticosteroids in other poisoning contexts does NOT apply to corrosive ingestion:
Dexamethasone has been used in paraquat poisoning (a different mechanism involving inflammatory lung injury), where combined methylprednisolone pulse therapy with prolonged dexamethasone showed benefit. 3
However, paraquat causes systemic inflammatory injury, whereas corrosive substances cause direct chemical burns with immediate tissue destruction—fundamentally different pathophysiology. 1, 3
Common Pitfalls
Do not confuse acute management with late stricture management. Corticosteroids have no role in the immediate post-ingestion period. 1
Do not use corticosteroids prophylactically to prevent stricture formation—the evidence supports their use only for established, persistent strictures after standard dilatation has failed. 2
Monitor for corticosteroid complications when using the high-dose protocol, including moon facies (which resolves with withdrawal), hyperglycemia, and infection risk. 2
The most serious late complications requiring this intervention are esophageal stenosis and gastric stenosis of the antrum and pylorus, which may develop weeks to months after the initial injury. 1