text: Common treatments used for toxic substance ingestions are ineffective, or are even harmful, when implemented in ingestions of caustic substances. Clinical attempts to empty the stomach can cause further injuries. Activated charcoal does not neutralize caustics and can also obscure endoscopic visualization. There is no known clinical benefit of neutralization of the caustic substances; neutralization releases heat as well as causing gaseous distention and vomiting, all of which can worsen injuries.
  Signs of airway compromise including decreased level of consciousness, stridor, change in voice, inability to control oral secretions necessitate intubation and mechanical ventillation. IV fluids are often needed to maintain hydration and replace insensible water losses.
  Endoscopy should be done within the first 24–48 hours of ingestion as subsequent wound softening increases the risk of perforation. Endoscopically inserted nasogastric tubes can serve as a stent to prevent esophageal strictures as well as allow tube feedings. A CT scan, often enhanced with contrast, can also be used to evaluate injuries.
  The most common surgical methods of treatment in children include esophageal dilation and esophageal replacement as less commonly implantation of an esophageal stent.