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Old 04-26-2012
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Poison Acute alkali ingestion management

When there is acute alkali ingestion after preventing further exposure and washing with water what should be the next step in management and why??
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And what could be the next step and best next step in management in above scenario??
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Old 04-26-2012
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Originally Posted by confident View Post
And what could be the next step and best next step in management in above scenario??
less than 24 hours it is ugi endoscopy. this is all i can rem...why? dont know...
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Old 04-26-2012
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Proton pump inhibitors reduce exposure of injured esophagus to gastric acid, which may result in decreased stricture formation.
Admit all symptomatic patients to the ICU to closely monitor their airway status and to watch for signs of perforation.
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Airway edema or obstruction may occur immediately or up to 48 hours following an alkaline exposure.
Gastroesophageal perforation may occur acutely.
Secondary complications include mediastinitis, pericarditis, pleuritis, tracheoesophageal fistula formation, esophageal-aortic fistula formation, and peritonitis.
Delayed perforation may occur as many as 4 days after an acid exposure.
Deep circumferential or deep focal burns may result in strictures in more than 70% of patients; these strictures typically develop 2-4 weeks postingestion.
Gastric outlet obstruction may develop 3-4 weeks after an acid exposure.
Upper gastrointestinal hemorrhage may occur acutely in caustic exposures.
Delayed upper GI bleeding may occur in acid burns 3-4 days after exposure as the eschar sloughs.
Though many button batteries may pass through the GI tract without causing damage, they can result in perforation at any time during their course through the gastrointestinal system, particularly if they are damaged.
Zinc chloride, mercuric chloride, and phenol can all cause significant systemic toxicity.
Cardiac arrest from sudden hypocalcemia may occur in patients who have ingested hydrogen fluoride–containing substances. Patients have been successfully resuscitated with aggressive use of intravenous CaCl2.
Long-term risks include squamous cell carcinoma, which occurs in 1-4% of all significant exposures and may occur as late as 40 years after exposure.
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Woho.. You know so much. Wow. WhEre scope fits in ur expln?
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Old 04-27-2012
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Quote:
Originally Posted by confident View Post
And what could be the next step and best next step in management in above scenario??
Need more info e.g. presentation. age, psychological problems, exam findings etc to answer those questions.

But here is the general management:

1. ABC --Airway to be more specific since the patient may have laryngeal burns leading to laryngeal edema and may require a Cricothyrotomy/ tracheostomy.

2. CxR to rule out perforation. (perforation rules out Endoscopy)--First step in management (if airway is not among the choice)

3. Endoscopoy-preferably within first 24 hours (once the patient is stable) to find out the extent of injury.--Best step, if CxR is normal

If in doubt about perforation, a gastrografin study may be done to confirm or r/o perforation.

Quote:
Chest radiography: Obtain an upright chest radiograph in all cases of caustic ingestion. Findings may include pneumomediastinum or other findings suggestive of mediastinitis, pleural effusions, pneumoperitoneum, aspiration pneumonitis, or a button battery (metallic foreign body). However, the absence of findings does not preclude perforation or other significant injury.
Abdominal radiography: Findings may include pneumoperitoneum, ascites, or an ingested button battery (metallic foreign body).
If contrast studies are obtained, water-soluble contrast agents are recommended because they are less irritating to the tissues in cases of perforation.
CT will often be able to delineate small amounts of extraluminal air, not seen on plain radiographs.
Quote:
Endoscopy is generally indicated for the following patients:
Small children
Symptomatic older children and adults
Patients with abnormal mental status
Those with intentional ingestions
Patients in whom injury is suspected for other reasons (eg, ingestion of large volumes or concentrated products)
However, because of the risk of increased injury, esophagoscopy should not be performed in patients with evidence of esophageal or gastrointestinal perforation, significant airway edema, or necrosis and in those who are hemodynamically unstable.
Endoscopic ultrasonography has been shown to more accurately show the depth of lesions than endoscopy alone.[6] Further studies will be necessary to determine the utility of this procedure in aiding in diagnosis and treatment.
Quote:
Dilution: Dilution may be beneficial for ingestion of solid or granular alkaline material if performed within 30 minutes after ingestion using small volumes of water. Because of the risk of emesis, carefully consider the risks versus benefits of dilution.

Last edited by Novobiocin; 04-27-2012 at 05:38 AM.
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Woho.. You know so much. Wow. WhEre scope fits in ur expln?


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Old 12-19-2014
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Search Looking for a caustic substance chart

Quote:
Originally Posted by Novobiocin View Post
Need more info e.g. presentation. age, psychological problems, exam findings etc to answer those questions.

But here is the general management:

1. ABC --Airway to be more specific since the patient may have laryngeal burns leading to laryngeal edema and may require a Cricothyrotomy/ tracheostomy.

2. CxR to rule out perforation. (perforation rules out Endoscopy)--First step in management (if airway is not among the choice)

3. Endoscopoy-preferably within first 24 hours (once the patient is stable) to find out the extent of injury.--Best step, if CxR is normal

If in doubt about perforation, a gastrografin study may be done to confirm or r/o perforation.



Can you tell me where I might find a chart with signs/symptoms/management of the different poisons (to differentiate bleach, drain cleaner, batteries, etc.). I could swear I saw this somewhere but haven't been able to locate it in Kaplan Peds, Kaplan Surgery, FA Step 1, FA Step 2 CK, Step Up To Medicine. I just can't locate it anywhere. Could you point me to such a table?
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