Omeprazole Administration in Corrosive Ingestion
In patients with documented corrosive ingestion, administer omeprazole as an 80 mg intravenous bolus over 1 hour, followed by continuous infusion at 8 mg/hour for 72 hours. 1
Dosing Protocol
Adult Dosing
- Initial bolus: 80 mg IV over 1 hour 2, 1
- Continuous infusion: 8 mg/hour for 72 hours 2, 1
- This high-dose regimen has demonstrated significant endoscopic healing in caustic esophageal injuries (p=0.004) when comparing pre- and post-treatment endoscopy at 72 hours 1
Pediatric Dosing
- Initial bolus: 40 mg/1.73 m² IV over 1 hour 2
- Continuous infusion: Adjust proportionally to body surface area (equivalent to adult 8 mg/hour rate) for 72 hours 2
- Alternative dosing for critically ill children: 0.5 mg/kg every 12 hours, with interval adjustment to every 6-8 hours if needed based on gastric pH monitoring 2
Route of Administration
Intravenous administration is mandatory in corrosive ingestion because:
- Oral intake must be withheld until the patient is stable 3, 4, 5
- The esophageal mucosa is damaged and cannot tolerate oral medications 5
- IV route ensures reliable drug delivery and immediate therapeutic effect 1
Duration and Monitoring
Initial Treatment Phase
- Continue IV omeprazole for 72 hours after admission 2, 1
- Perform control endoscopy at 72 hours to assess healing response 1
- Maintain NPO (nothing by mouth) status during this period 3, 5
Transition to Oral Therapy
- Allow oral intake only after achieving hemodynamic stability for 4-6 hours post-endoscopy 2
- The evidence does not specify exact transition protocols from IV to oral omeprazole in corrosive injury, but standard practice would involve switching to oral omeprazole 20-40 mg twice daily once oral intake is tolerated 6
Critical Management Context
What NOT to Do
The following are absolutely contraindicated in corrosive ingestion 3, 5:
- Do not induce vomiting 3, 5
- Do not perform gastric lavage 3, 4, 5
- Do not administer neutralizing agents 3, 5
- Do not use activated charcoal (ineffective in corrosive injury) 5
Concurrent Management Priorities
Before initiating omeprazole, ensure 3, 4:
- Airway, breathing, and circulation are stabilized 3, 4
- Surgical consultation obtained early if signs of perforation or transmural necrosis are present 3, 4
- CT scan performed 3-6 hours post-ingestion to assess for transmural injury 3
Evidence Quality Note
The recommendation for high-dose IV omeprazole (80 mg bolus + 8 mg/hour infusion) comes from a prospective case series specifically evaluating caustic esophageal injury 1, which demonstrated statistically significant endoscopic healing. This dosing regimen mirrors the protocol used successfully in bleeding peptic ulcers 2, where it reduces rebleeding rates and transfusion requirements. While the evidence level is not from randomized controlled trials, it represents the best available data for this specific clinical scenario and has shown clinical benefit without mortality in the follow-up period 1.