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