Endoscopic examination within the first 12 to 24 hours

An 18-month-old infant is found with the contents of a bottle of drain cleaner in his mouth. Which of the following treatment options is most appropriate?

  1. Immediate emesis
  2. Endoscopic examination within the first 12 to 24 hours
  3. Decontamination by activated charcoal
  4. Neutralization by drinking a solution of the opposite pH
  5. Have the patient drink copious amounts of milk or water

Explanation

Endoscopic examination of the esophagus and stomach is a diagnostic method of determining the extent of the mucosal injury. Vomiting is to be avoided since it would expose the mucosal surfaces to the caustic agent a second time. The child can be given small amounts of milk or water, but large amounts, which might cause vomiting, are unwise. Neutralization of the caustic can result in an exothermic reaction and produce a thermal burn. The use of steroids after endoscopy in second-degree chemical burns of the esophagus has been effective in diminishing the inflammatory response in some patients. Optimal treatment is still controversial and requires expert consultation or review of the most current literature. Charcoal, however, does not absorb the alkaline agent in drain cleaner.