救急 / 中毒 / 消化器
腐食性物質（強酸/強アルカリ）誤飲 — 管理パス
催吐/洗浄/中和/活性炭は禁忌。気道優先、早期内視鏡で重症度評価。
根拠：Merck / WSES。各ノードはガイドラインの判断ロジックを要約したものであり、原文の転載ではありません。 医療従事者向けの参考情報であり、臨床判断の代替ではありません。日本の関連学会指針および施設プロトコルを優先してください。
ステップごとに回答すると、結論と対応の目安が表示されます。前の質問に戻ることもできます。
ステップ 1 · Airway and symptoms
Caustic ingestion — airway and symptoms?
💡 Strong acid (coagulation necrosis, mostly injures the stomach) vs strong alkali (liquefaction necrosis, penetrates deep, injures the esophagus, e.g. drain cleaner). Management is similar for both. Contraindications (the 'four nos'): no induced emesis, no gastric lavage, no neutralization (acid-base neutralization is exothermic and worsens injury), no activated charcoal (does not adsorb and obscures endoscopy; except with systemic toxicity such as zinc/mercury chloride). Milk/water dilution only in the first few minutes (controversial).
パス全体像
- 【判断】Airway and symptomsCaustic ingestion — airway and symptoms?（Strong acid (coagulation necrosis, mostly injures the stomach) vs strong alkali (liquefaction necrosis, penetrates deep, injures the esophagus, e.g. drain cleaner). Management is similar for both. Contraindications (the 'four nos'): no induced emesis, no gastric lavage, no neutralization (acid-base neutralization is exothermic and worsens injury), no activated charcoal (does not adsorb and obscures endoscopy; except with systemic toxicity such as zinc/mercury chloride). Milk/water dilution only in the first few minutes (controversial).）
- Airway involvement/symptomatic/intentional ingestion → Airway involvement/intentional → airway + early endoscopy
- Asymptomatic, small accidental ingestion → Asymptomatic · observe
- 【終点】Asymptomatic · observe少量の偶発誤飲でも催吐・胃洗浄・中和・活性炭は禁忌。気道優先、早期内視鏡で重症度評価。
- 【終点】Airway involvement/intentional → airway + early endoscopyAirway involvement (stridor/drooling/voice change)/有症状/intentional ingestion: airway first (anticipate swelling/閉塞 — 挿管 under direct bronchoscopic vision, avoid blind 挿管, use paralytics cautiously 〜あり 重症 distortion; surgical airwayの場合needed) + hemodynamic stability (輸液/vasopressors); no emesis/lavage/neutralization/charcoal; early endoscopy (EGD) グレード判定 at 12–24 h (Zargar, no later than 48 h, stop at 重症 injuryへavoid 穿孔); CTへassess transmural necrosis/穿孔. High-grade/穿孔/peritonitis → 手術. Long term: esophageal stricture (dilation), cancer risk.
よくある質問
- 腐食性物質（強酸/強アルカリ）誤飲 — 管理パスはどの臨床課題を扱う診療パスですか？
- 催吐/洗浄/中和/活性炭は禁忌。気道優先、早期内視鏡で重症度評価。
- 腐食性物質（強酸/強アルカリ）誤飲 — 管理パスの主要な意思決定ステップは何ですか？
- Airway and symptoms
- 腐食性物質（強酸/強アルカリ）誤飲 — 管理パスはどのような対応方針を示しますか？
- Asymptomatic · observe：少量の偶発誤飲でも催吐・胃洗浄・中和・活性炭は禁忌。気道優先、早期内視鏡で重症度評価。；Airway involvement/intentional → airway + early endoscopy：Airway involvement (stridor/drooling/voice change)/有症状/intentional ingestion: airway first (anticipate swelling/閉塞 — 挿管 under direct bronchoscopic vision, avoid blind 挿管, use paralytics cautiously 〜あり 重症 distortion; surgical airwayの場合needed) + hemodynamic stability (輸液/vasopressors); no emesis/lavage/neutralization/charcoal; early endoscopy (EGD) グレード判定 at 12–24 h (Zargar, no later than 48 h, stop at 重症 injuryへavoid 穿孔); CTへassess transmural necrosis/穿孔. High-grade/穿孔/peritonitis → 手術. Long term: esophageal stricture (dilation), cancer risk.
- 腐食性物質（強酸/強アルカリ）誤飲 — 管理パスのうち直ちに対応が必要な状況はどれですか？
- Airway involvement/intentional → airway + early endoscopy：Airway involvement (stridor/drooling/voice change)/有症状/intentional ingestion: airway first (anticipate swelling/閉塞 — 挿管 under direct bronchoscopic vision, avoid blind 挿管, use paralytics cautiously 〜あり 重症 distortion; surgical airwayの場合needed) + hemodynamic stability (輸液/vasopressors); no emesis/lavage/neutralization/charcoal; early endoscopy (EGD) グレード判定 at 12–24 h (Zargar, no later than 48 h, stop at 重症 injuryへavoid 穿孔); CTへassess transmural necrosis/穿孔. High-grade/穿孔/peritonitis → 手術. Long term: esophageal stricture (dilation), cancer…
- 腐食性物質（強酸/強アルカリ）誤飲 — 管理パスはどのガイドラインに基づいていますか？
- Caustic ingestion (Merck Manual; StatPearls; WSES) · 準拠：Merck / WSES
出典
- Caustic ingestion (Merck Manual; StatPearls; WSES)