A 3-year-old swallowed toilet cleaner (strong alkali) 2 hours ago. He has drooling, oral burns, and refuses to swallow but is maintaining his airway with stridor absent. What is the most appropriate next step?
- A Upper gastrointestinal endoscopy within 12 to 24 hours ✓
- B Neutralize the alkali with dilute vinegar orally
- C Induce vomiting to remove residual corrosive
- D Barium swallow to assess esophageal injury
Correct answer: A. Upper gastrointestinal endoscopy within 12 to 24 hours
Explanation
Corrosive ingestion causes liquefactive necrosis with deep penetration, especially with alkali. Emesis, gastric lavage, and neutralization are all contraindicated because re-exposure worsens injury. Early upper GI endoscopy within 12 to 24 hours grades mucosal damage and predicts stricture risk. Barium swallow understates injury and is reserved for late stricture assessment, which makes it the tempting but wrong distractor.
Reference: Goldfrank's Toxicologic Emergencies, 11th ed.
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