Artificial Nutrition in Therapeutic Approach of Acute Caustic Poisonings

Abstract

Acutes corrosive poisonings can cause serious chemical injuries of the upper gastrointestinal tract, and they are localized most frequently in the esophagus and the stomach because the poison remains there a long time. Treatment of the acute corrosive intoxications include: neutralization of corrosive agents, antibiotics, corticosteroids, anti-secretory therapy, nutritional support, collagen synthesis inhibitors, esophageal dilation and stent placement, and surgery. The damaged mucosa, submucosa and muscle layer regenerate with great difficulty because of the surrounding inflammation, necrosis and secondary complications. Tissue fibrosis, adhesions or circular stenosis appear, which greatly disturb the normal functioning (impeded peristaltic, impeded passage). All these complicate the entire general condition of the patient, including inadequate normal food intake, loss of body weight, prostration, cachexia. These patients are also into a severe general condition due to hypercatabolic state and negative alkali balance. Therefore, early nutritional support is of substantial importance in treatment of these patients. Nutritional support can be given by parenteral way in peripheral or central vein and by enteral way through specially designed tubes inserted in the stomach or intestines, prepyloric or postpyloric. The type of artificial nutritional support will depend on the grade of esophageal or gastric damage determined by endoscopy.