List the potential complications associated with the management of a patient after intentional corrosive ingestion.

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College Answer

Potential complications of intentional corrosive ingestion include: 
•  Acute:Oral, oesophageal, gastric bums of varying thickness Laryngeal oedema and airway obstruction Oesophageal, gastric perforation 
Shock Haemorrhage Mediastinitis Psychiatric problems 
•  Chronic/late: 
Laryngopharyngo fibrosis with airway incompetence and chronic aspiration 
Oesophageal fibrosis, stricture and stenosis 
Psychosocial problems 
Carcinoma

Discussion

This question would benefit from a systematic response.

  • Airway:
    • Airway burns, leading to airway compromise
    • Potential acute tracheo-oesophageal fistula due to corrosive effect on oesophagus
    • Assessment and immediate airway control is a priority
  • Breathing:
    • Potential aspiration of caustic gastric/oesophageal contents, thus acute lung injury
    • Hypoxia may be present; supplemental oxygen may be required. NIV may be contraindicated in case of full-thickness oesophageal injury
  • Circulation:
    • Potential hypovolemic shock due to fluid loss into the corroded gut, or haemorrhage though ulcers
    • Need for rapid fluid replacement or surgical haemostasis
    • CVC access, as this patient is likely to require long-term TPN
  • Neurological state:
    • Potential for disorganised behaviour due to psychiatric condition, or obtundation due to shock
    • Analgesia issues need to be addressed
  • Electrolyte disturbance
    • Absorption of corrosive agent may result in electrolyte and acid-base disturbance
  • Fluid balance
    • Likely, hypovolemia will exist and need correction
    • renal impairment may be present, with implications on drug dosing
  • Gastrointestinal problems:
    • Extent of corrosive damage will need to be assessed by CT and/or direct endoscopy (earlier is better, before significant tissue softenting makes endoscopy risky)
    • Perforation of hollow organs must be ruled out with CXR and/or CT
  • Specific issues
    • Decontamination by NG aspiration may be possible if it is safe to pass an NGT

References

Ramasamy, Kovil, and Vivek V. Gumaste. "Corrosive ingestion in adults." Journal of clinical gastroenterology 37.2 (2003): 119-124.