Agrochemical and household poisons

Corrosive and hydrocarbon (kerosene) ingestion

Reviewed Nov 2026·1 references
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Corrosives: protect the airway, no emesis, neutralisation or blind NG tube; early endoscopy (within 12-48 h) or CT to grade injury and identify perforation needing surgery. Hydrocarbons: the danger is aspiration pneumonitis; no lavage or emesis; supportive respiratory care.

At the bedside

Timed steps
  1. 1

    Airway first

    Corrosive

    Stridor, drooling, hoarseness: early senior airway management (fibreoptic/surgical airway ready); avoid blind intubation attempts.

  2. 2

    Do not

    Corrosive

    Induce vomiting, give neutralising agents or activated charcoal, or insert a blind NG tube.

  3. 3

    Assess

    Corrosive

    Erect CXR/CT for perforation (mediastinitis, peritonitis); endoscopy within 12-48 h (avoid days 5-15) with Zargar grading.

  4. 4

    Manage by grade

    Corrosive

    Grade 0-1: early oral intake. 2a: liquids, PPI. 2b-3a: nil by mouth, feeding jejunostomy/NJ, monitor for strictures. 3b (extensive necrosis) or perforation: emergency surgery.

  5. 5

    Aspiration

    Hydrocarbon

    Cough, choking, tachypnoea within hours: CXR changes may lag 6 h; oxygen, HFNC/NIV or lung-protective ventilation; no prophylactic antibiotics or steroids. Observe 6 h; asymptomatic with normal CXR can go home.

Zargar endoscopic classification of corrosive injury

GradeFindingImplication
0NormalDischarge
1Oedema, hyperaemiaLow risk
2aFriability, erosions, superficial ulcers, exudateLow stricture risk
2bAs 2a plus deep discrete or circumferential ulcersHigh stricture risk
3aSmall scattered necrosisHigh stricture risk
3bExtensive necrosisHigh mortality; surgery

Grades 2b and above predict stricture; 3b predicts perforation and death.

Red flag · call your senior now
Chest or abdominal pain, subcutaneous emphysema, fever or shock after corrosive ingestion: perforation.
Pitfall
Blind NG tube in corrosive injury (perforation).
Pitfall
Gastric lavage after kerosene ingestion (increases aspiration).
Pearl
Acids (toilet cleaner, battery acid) injure the stomach more; alkalis injure the oesophagus more.

References

  1. 1

    Zargar SA, Kochhar R, Mehta S, Mehta SK. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc. 1991;37(2):165-169

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