Gastric decontamination is a difficult issue because much of the morbidity and death related to caustic ingestion is secondary to destruction of the GI tract. Caustics do not bind well to activated charcoal, and charcoal is not useful in either alkali or acid ingestions. Gastric lavage and ipecac are also not used. They may increase the risk for repeat exposure to the ingested caustics secondary to vomiting. Nasogastric (NG) tube placement is also controversial. The use of an NG tube is contraindicated in obvious gastric or esophageal perforation. An NG tube is also not used after alkali ingestions, because the risk of GI perforation is considered too great. In cases of strong acid ingestion, the risk for perforation is considered lower because coagulation necrosis may protect deeper tissue from injury. Placement of a small NG tube under endoscopic guidance has been recommended by some to aspirate residual acid from the stomach.
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