The mother of a 2-year-old boy calls you because she found her son holding an open bottle of liquid dishwasher detergent. He is crying, drooling profusely, and has vomited three times. In answer to your questions, she reports that he is not sleepy and did not seem to get it in his eyes or on his skin. On examination in your office, you note an ulcer on his lower lip and several ulcers on his tongue.
Of the following, the most appropriate next step in the evaluation and management of this boy is to
A. administer activated charcoal
B. administer ipecac syrup
C. reassure the mother that the product is nontoxic
D. refer the boy to a gastroenterologist for urgent endoscopy
E. refer the boy to the emergency department for gastric lavage
ENDOSCOPY CAN CAUSE PERFORATION ON NOT???
what are you doing here go get some rest you know it all don't worry
yes answer is D
Dishwasher detergent is a highly caustic alkali that can cause significant oropharyngeal, upper airway, and esophageal injury if ingested. Alkaline agents cause deep liquefaction necrosis of the affected tissues, with ulceration and perforation likely complications. Common household products such as oven and drain cleaners, dishwasher detergents, and cleaning products that contain ammonia pose a risk of caustic injury. Substances that have a pH greater than 11 are likely to cause injury, even in small amounts.
Children who have ingested caustic or corrosive agents typically present with drooling, dysphagia, or emesis, as reported for the boy in the vignette, although the presence and severity of symptoms is not predictive of esophageal injury. The presence or absence of oral lesions also is not predictive of esophageal injury.
The initial evaluation and treatment of patients who have ingested caustic substances includes stabilization of vital functions, pain management, and other supportive measures. Decontamination with activated charcoal is not indicated because it will not adsorb acids or alkalis and is likely to impair endoscopic evaluation. Use of ipecac syrup or gastric lavage is contraindicated because of the potential to cause further injury to the esophagus. In the symptomatic patient, endoscopy should be undertaken within 6 to 24 hours of ingestion to determine the presence of esophageal burns and the degree of severity.
Evaluation of the asymptomatic patient is controversial. Because the available data suggest that esophageal burns may be found in as many as 45% of those who do not have oral lesions, endoscopy is recommended in clear cases of ingestion. If the history is questionable and the patient remains asymptomatic, with normal swallowing, after several hours of observation, some authors have suggested that it is safe to forego endoscopy.
Yes, bec I miss you..haha, so tired..