What is the role of gastric emptying and decontamination in the emergency department care of caustic ingestions?

Updated: Dec 09, 2020
  • Author: Derrick Lung, MD, MPH, FACEP, FACMT; Chief Editor: David Vearrier, MD, MPH  more...
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Answer

Do not administer emetics because of potential re-exposure of the vulnerable mucosa to the caustic agent. This may result in further injury or perforation.

Gastric lavage by traditional methods using large-bore orogastric Ewald tubes is contraindicated in both acidic and alkaline ingestions because of risk of esophageal perforation and tracheal aspiration of stomach contents.

In large-volume liquid acid ingestions, nasogastric tube (NGT) suction may be beneficial if performed promptly after ingestion. Pyloric sphincter spasm may prolong contact time of the agent to the gastric mucosa for up to 90 minutes. NGT suction may prevent small intestine exposure. Esophageal perforation is rare. NGT suction may be of particular value following ingestion of zinc chloride, mercuric chloride, or hydrogen fluoride, unless signs of perforation are present. Of note, intubation with sedation is likely necessary for patients to tolerate this procedure and allow clinicians to perform it without instigating secondary esophageal injury (from vomiting) and or aspiration. This should be done after consulting with a regional poison control center.

Activated charcoal is relatively contraindicated in caustic ingestions because of poor adsorption and endoscopic interference.


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