🧪 Chapter 125: Corrosive Poisoning

Acids (coagulation necrosis) vs alkalis (liquefaction necrosis) · Contraindications: gastric lavage, activated charcoal, neutralisation · Airway oedema · Early endoscopy (6-24h) · Stricture formation · No steroids · TPN for severe burns

🔍 Core Concepts: Corrosive Poisoning

📌 Types & Mechanisms
Acids: coagulation necrosis (scar forms a barrier, limits depth). Alkalis: liquefaction necrosis (deep penetration, more severe injury). Common agents: toilet cleaners (acid), drain openers (alkali), bleach.
🚫 Contraindicated Decontamination
NO gastric lavage, NO activated charcoal, NO neutralisation (heat release causes more injury). NO emesis. Dilution with water/milk only if within minutes of ingestion.
🫁 Airway Management
Stridor, drooling, hoarseness → impending airway oedema. Early intubation before oedema worsens. Use smaller ETT. ENT backup for tracheostomy.
🔬 Endoscopy (Gold Standard)
Within 6-24h (or after stabilisation) to grade injury (Zargar classification): Grade 0 normal, I oedema, IIa ulceration/bleeding, IIb deep ulceration, III perforation risk. Repeat at 3-4 weeks for stricture.
💊 No Role for Steroids
Steroids not proven to prevent strictures, may increase perforation risk. Avoid. Antibiotics only if documented infection.
🍽️ Nutrition
If unable to swallow or severe injury (grade IIb/III): TPN or nasojejunal feeds (avoid NG tube if oesophageal injury).

🩺 Stepwise Approach: Corrosive Ingestion

1
Immediate airway assessment
Look for stridor, hoarseness, drooling, respiratory distress. If present, intubate early (risk of rapid airway oedema). Use smaller ETT, ENT backup for tracheostomy.
2
NO gastric decontamination
Do NOT give activated charcoal, gastric lavage, or emesis. Do NOT neutralise with acid/alkali (exothermic reaction). Dilution with water/milk only if within minutes of ingestion and patient cooperative.
3
Supportive care & NPO
Keep nil per os. IV fluids, pain management (opioids). Do NOT pass NG tube (risk of perforation).
4
Endoscopy (gold standard)
Perform within 6-24h (or after stabilisation) to grade injury using Zargar classification. Do NOT perform endoscopy between 5-15 days (high perforation risk).
5
Nutrition plan based on grade
Grade I-IIa: may start oral fluids after 24-48h. Grade IIb-III: TPN or nasojejunal feeds (avoid NG tube). Stricture risk: repeat endoscopy at 3-4 weeks.
6
No steroids, no prophylactic antibiotics
Steroids not proven beneficial; may increase perforation risk. Antibiotics only if documented infection or perforation.