Ver el código de «Caustic ingestion»

==Background==
{{Caustics background}}

==Clinical Features==
{{General approach to caustic burns}}

==Differential Diagnosis==
{{Caustic burn types}}

==Evaluation==
===Labs===
Only necessary in patients with significant injury or volume of ingestion

*CBC
*Chemistry
*Lactic Acid
*[[ECG]]
*Calcium level (if Hydrofluoric Acid exposure)
*Acetaminophen and Salicylate levels (in patients with concern for intentional ingestion)

===Imaging===
*3-View CXR CXR
**Look for free air under the diaphragm or signs of mediastinal air<ref>Muhletaler C. et al. Acid corrosive esophagitis: radiographic findings. AJR Am J Roentgenol. 1980. Jun;134(6):1137-40. PMID: 6770621</ref>
*CT
**Consider when perforated viscus is suspected but CXR is negative
*Button battery XR - two rings, will likely need to remove it no matter where it is, whether post-pyloric or pre-pyloric

==Management==
*Prevent provider and continued patient exposure to the caustic agent by removing all clothing and decontaminating the patient

===Airway Management===
*Monitor closely for [[stridor]], airway edema, hoarseness, or other signs of airway injury
*[[Intubate]] early if signs of airway injury exist, before airway becomes more difficult to manage.
*Consider awake fiberoptic or video laryngoscopy if concern for difficult airway
*Blind nasotracheal intubation is contraindicated due to the potential for perforations and false passages

===Endoscopy===
Should be performed within 12-24 hours of ingestion (too early can underestimate extent of injury, too late increases risk of wound softening and perforation).

;Indications:
*Intentional ingestion (higher likelihood of high volume ingestion)
*Unintentional ingestion with signs of:
**[[Stridor]]
**Significant oropharyngeal burns
**[[Vomiting]]
**Drooling
**Food refusal

===Esophageal Stricture Mitigation<ref>High Doses of Methylprednisolone in the Management of Caustic Esophageal Burns. Pediatrics 2014;133:e1518–e1524</ref>===
*Discuss with GI or medical toxicologist
*For grade IIb or higher esophageal burns:
**[[Methylprednisolone]] (1 g/1.73 m2 per day for 3 days)
**[[Ranitidine]]
**[[Ceftriaxone]]
**Total parenteral nutrition

===Surgical Intervention===
*Indicated for:
**Perforation
**Peritoneal signs

===Controversial or Contraindicated===
*[[Antibiotics]]
**No evidence to support or reject the use of prophylactic [[antibiotics]]
**Only indicated if also giving [[steriods]] (see stricture mitigation above)
*[[Activated charcoal]]
**Only consider when coingestants pose a risk for severe systemic toxicity
*[[Gastric lavage]]
**Contraindicated due to potential to cause reflux of caustic agent into esophagus, creating more damage
*Dilution with water or milk causes vomiting, elevating risk for perforation
**Possible benefit only for solid alkali ingestions
*Neutralization generates excess heat
**Milk or magnesium citrate only for [[hydrofluoric acid]] ingestion

==Disposition==
*All patients with symptomats from a caustic ingestion should be admitted
*All patients with intentional ingestion should be evaluated by psych prior to discharge

===Prognosis===
*depending severity may have full return of mobility and function or can progress to perforation followed by stricture formation 
*'''Days 2-14''' post-injury are associated with highest tissue friability / risk of perforation
*High-grade caustic burns associated with 1000x increase in esophageal SCC

==See Also==
*[[Caustic burns]]

==References==
<references/>

[[Category:GI]]
[[Category:Toxicology]]