Montmorillonite is Contraindicated in Corrosive Ingestion Management
Montmorillonite should NOT be used in the acute management of corrosive substance ingestion, as neutralizing agents and adsorbents are absolutely contraindicated and can cause further injury including perforation. 1
Why Montmorillonite and Similar Agents Are Harmful
The fundamental principle in corrosive ingestion management is to avoid any intervention that could cause additional mechanical or chemical trauma to already damaged tissues. 1
Neutralizing agents and adsorbents (including montmorillonite) are absolutely contraindicated because they can generate exothermic reactions, cause further tissue damage, and potentially lead to perforation. 1
Activated charcoal has no effect and is not indicated in corrosive ingestions, and the same principle applies to clay-based adsorbents like montmorillonite. 2
The only acceptable dilution approach is water or milk within 60 minutes of ingestion, but this window is narrow and the benefit limited. 2
What IS Indicated Instead
Immediate Management Priorities
Assess airway, breathing, and circulation first, monitoring for respiratory distress from vapor aspiration or upper airway edema. 1
Do NOT induce vomiting, perform gastric lavage, or administer any neutralizing agents - these interventions can cause perforation and worsen outcomes. 1, 2
Diagnostic Approach
Perform contrast-enhanced CT scan 3-6 hours after ingestion as the primary diagnostic modality, as CT outperforms endoscopy in detecting transmural injuries and predicting stricture formation. 1, 3
Initial laboratory evaluation should include CBC, electrolytes (sodium, potassium, chlorine, magnesium, calcium), renal function, liver tests, pH, serum lactate, and β-HCG in young women. 4
Treatment Based on Injury Severity
Non-operative management for patients without full-thickness necrosis (CT Grades I, IIa, IIb). 3
Emergency surgical intervention is indicated for transmural necrosis (Grade III CT findings), gastrointestinal perforation with mediastinitis or peritonitis, and progressive clinical deterioration. 1, 3
Critical Pitfalls to Avoid
Never rely on clinical symptoms alone to assess severity - the absence of pain and oral lesions does not rule out life-threatening gastrointestinal injuries. 4
Avoid endoscopy between 1-3 weeks post-ingestion due to significantly higher perforation risk during the healing phase. 3
Do not delay surgical intervention when transmural necrosis is present, as this increases mortality. 3