A 2-year-old swallowed liquid drain cleaner containing concentrated sodium hydroxide. He is drooling with oropharyngeal burns but has no stridor or respiratory distress. Which statement about his management is correct?

• A Alkalis cause coagulation necrosis limited to the mucosal surface, so injury is superficial
• B Neutralize the alkali by giving dilute vinegar orally before transfer
• C Prophylactic broad-spectrum antibiotics are indicated in every case of caustic ingestion
• D Upper gastrointestinal endoscopy within 12 to 24 hours grades the extent of esophageal injury ✓

Explanation

Concentrated alkalis cause liquefactive necrosis with saponification of fats, allowing deep penetration into the esophageal wall, so injuries are frequently transmural rather than superficial. Endoscopy performed within 12 to 24 hours is the standard method to grade injury and guide steroid and dilation decisions. Neutralizing agents generate heat and worsen damage, and antibiotics are reserved for proven infection or severe grades, not given routinely.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.