Question

For gastric lavage the only absolute contraindication is corrosive poisoning except

• A. \( \text{Oxalic acid} \)
• B. \( \text{Salicylic acid} \)
• C. \( \text{Carbolic acid} \)
• D. \( \text{Nitric acid} \)

Hint:

\textbf{Medical Toxicology: Gastric Lavage in Corrosive Poisoning.} While generally contraindicated, the decision to perform gastric lavage in corrosive poisoning is complex and depends on the specific agent, the time since ingestion, the amount ingested, and the clinical condition of the patient. Early consultation with a toxicologist is crucial.

Answer 1

The Correct Option is A

Gastric lavage is generally contraindicated in corrosive poisoning due to the risk of further damage to the esophagus and stomach during the passage of the lavage tube and the return of the corrosive substance. However, there are exceptions where gastric lavage might be considered with extreme caution, particularly if performed very early after ingestion (within one hour) and if the amount ingested is life-threatening. Let's analyze the options: \begin{itemize} \item Oxalic acid: This is a corrosive substance. However, it also binds with calcium, potentially leading to hypocalcemia. Ingestion can be rapidly fatal, and early gastric lavage might be considered in significant ingestions despite the corrosive nature, primarily to remove unabsorbed oxalate and prevent systemic toxicity. \item Salicylic acid: This is not a corrosive substance. Gastric lavage is often indicated in salicylic acid poisoning to reduce absorption. \item Carbolic acid (Phenol): This is a corrosive substance that can cause severe local damage. Gastric lavage is generally contraindicated due to the risk of further injury. However, similar to other strong corrosives, very early lavage might be considered in severe cases under strict medical supervision. \item Nitric acid: This is a strong corrosive acid, and gastric lavage is typically absolutely contraindicated due to the significant risk of perforation and further damage. \end{itemize} The question asks for the exception to the absolute contraindication of gastric lavage in corrosive poisoning. While generally contraindicated, very early gastric lavage might be cautiously considered in severe poisoning with oxalic acid to prevent systemic toxicity and potentially with carbolic acid if ingestion is recent and life-threatening. Salicylic acid poisoning is not a corrosive ingestion, so gastric lavage is not contraindicated for this reason. Nitric acid ingestion is generally considered an absolute contraindication for gastric lavage. Considering the options and the nuances in managing corrosive ingestions, both Oxalic acid and Carbolic acid could be considered exceptions where very early and cautious gastric lavage might be contemplated in specific severe scenarios, outweighing the risks of no intervention. The provided correct option indicates both (1) and (3).