Neutralization and Dilution

Recommendations about dilution and or neutralization therapy after caustic ingestions vary. Dilution of caustic alkalis with water or milk has been shown to decrease tissue destruction in animal models.7 The literature generally recommends dilution therapy with 1 to 2 cups of water or milk early after alkali exposures. The toxicology literature suggests a greater theoretical benefit to dilution in treating solid alkali ingestions, because dilution might wash off adherent particles. Potential dangers of such therapy include vomiting, which may lead to further exposure of the esophagus and airway to caustic material and/or aspiration. Dilution therapy is contraindicated with patients who have obvious signs of perforation or airway injury. Most sources do not recommend dilution therapy for the treatment of acid ingestion. Rather, placement of a small NG tube with aspiration of gastric contents appears to be the chief means of gastric decontamination.

Neutralization therapy has long been considered contraindicated in caustic ingestions, because neutralization of strong bases with acids (and the reverse) are exothermic reactions. It is feared that the heat generated during neutralization could worsen injuries. Recently, a series of animal studies by Homan and colleagues 8 has questioned the significance of heat generated during neutralization therapy. Currently, the best recommendation with respect to dilution or neutralization therapy is small volumes of water or milk in alkali ingestions without signs of perforation. Neutralization of alkali with weak acids is contraindicated until further study and data are available.

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