A 35-year-old factory worker presents to the emergency department after accidental ingestion of a strong alkali substance. Which of the following is the BEST initial management strategy?
Perform immediate gastric lavage
Avoid inducing emesis and dilute with water or milk
Neutralize with a weak acid solution
Induce emesis immediately
The correct answer is to avoid inducing emesis and dilute with water or milk. This is the best initial management strategy for alkali ingestion because:
Inducing emesis is contraindicated in alkali ingestions as it can cause re-exposure of the esophagus to the corrosive substance, potentially worsening the injury.
Dilution with water or milk helps to reduce the concentration of the alkali and minimize further tissue damage. This should be done immediately if the patient is alert and able to swallow.
Neutralization with weak acids is not recommended as it can cause an exothermic reaction, potentially increasing tissue damage.
Gastric lavage is generally contraindicated in corrosive ingestions due to the risk of perforation and aspiration.
It's important to note that while dilution is the best initial step, the patient will require further assessment and management, including possible endoscopy and supportive care.
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