Nasojejunal Tube Feeding And Clinical Pharmacy Intervention In The Management of Caustic Esophageal Injury: A Case Report

Nasojejunal Tube Feeding And Clinical Pharmacy Intervention In The Management of Caustic Esophageal Injury: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Nasojejunal Tube Feeding And Clinical Pharmacy Intervention In The Management of Caustic Esophageal Injury: A Case Report Mohammed Misbah Ul Haq, Mohammed Ansar, Aieman Siddiqua, Mohd Mudaseer This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5814960/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Accidental ingestion of corrosive substances, such as sulfuric acid, is a rare but serious medical emergency, particularly in children. Such incidents can result in significant morbidity, including damage to the gastrointestinal tract, and require prompt and comprehensive management. This case is unique as it demonstrates the successful treatment of a 7-year-old boy who ingested sulfuric acid, providing valuable insights into effective clinical interventions. By documenting this case, we aim to expand the knowledge base for managing complex pediatric corrosive ingestion cases, offering a framework for similar scenarios in future clinical practice. Case Presentation: A 7-year-old boy accidentally ingested a mixture of sulfuric acid and water, presenting with severe vomiting and gastrointestinal bleeding. Upon arrival at the hospital, he was hemodynamically stable but exhibited signs of upper gastrointestinal distress. Initial evaluation included physical examination and imaging to assess the extent of damage. A multidisciplinary approach was adopted, starting with nasojejunal tube feeding to bypass the injured esophagus and ensure adequate nutrition. Medications, including proton pump inhibitors to reduce acid secretion and antibiotics to prevent secondary infections, were administered. The patient's vital signs were closely monitored, and a strict dietary plan was implemented, avoiding irritants and promoting gastrointestinal healing. Endoscopy was deferred to avoid further trauma to the already compromised tissue. Over several weeks, the patient showed significant improvement, with resolution of symptoms and no evidence of complications such as stricture formation or perforation. Follow-up care focused on nutritional recovery, psychological support, and education to prevent similar incidents. Conclusion: This case illustrates the critical importance of early recognition and immediate, targeted interventions in managing pediatric acid ingestion. The combination of nasojejunal feeding, vigilant monitoring, and tailored pharmacological and dietary management contributed to a positive outcome. The successful resolution of this complex case without long-term complications highlights effective strategies that can guide clinicians facing similar challenges. By sharing this case, we aim to contribute to the growing body of evidence on pediatric corrosive ingestion management, ultimately enhancing future clinical practices. sulfuric acid ingestion Naso-jejunal tube pediatric gastroenterology acid-related injuries child health BACKGROUND Acid ingestion is a significant medical emergency that can cause severe damage to the gastrointestinal (GI) tract and other organ systems. Accidental ingestion of caustic substances is common in children and can lead to life-threatening injuries, such as perforation, strictures, and even death. Sulfuric acid is a strong mineral acid that is commonly used in various industrial processes and laboratories. It is highly corrosive and can cause severe injuries upon ingestion. Therefore, it is crucial to manage such cases promptly and effectively to prevent long-term complications and improve the patient's outcome. The incidence of accidental acid ingestion among children is high, and it is estimated that approximately 6% of all pediatric poisoning cases are due to caustic substances ingestion ( 1 ). Younger children are at a higher risk of such accidents due to their curiosity and oral exploration behavior. Moreover, children with cognitive or developmental disabilities are also at a higher risk of accidental poisoning. Ingestion of sulfuric acid can cause immediate damage to the mucosa of the oral cavity, esophagus, and stomach. The degree of damage depends on the concentration and volume of the ingested acid, as well as the duration of exposure. The immediate symptoms include pain, drooling, dysphagia, vomiting, hematemesis, and respiratory distress. In severe cases, shock, cardiac arrest, and death may occur. The management of acid ingestion involves rapid assessment of the patient's airway, breathing, and circulation, followed by stabilization and decontamination of the gastrointestinal tract. Endoscopy is a crucial tool in the evaluation and management of acid ingestion cases. It helps in assessing the extent and severity of the mucosal injury, identifying the presence of strictures or perforations, and guiding the appropriate treatment. The timing of endoscopy depends on the patient's clinical condition and the severity of the injury. Early endoscopy is recommended for patients with a high risk of severe injury, such as those with a history of caustic ingestion with significant symptoms, such as dysphagia, chest or abdominal pain, and hematemesis or melena ( 2 ). In the case presented, a 7-year-old boy was brought to the hospital after accidentally ingesting a mixture of sulfuric acid and water. The patient had four episodes of vomiting containing blood, and a systemic examination revealed a normal cardiovascular and respiratory system, but a dull and lethargic nervous system. The patient was admitted for further care and management, and the physician's plan included marking a Naso-jejunal Tube (NJ) at the nasal end, administering slow boluses over 20 minutes, monitoring for abdominal distension and pain, stopping intravenous fluids after 2 hours of starting NJ feeds, continuing injection pantoprazole, and monitoring vitals and strict input/output chart. The plan also included informing the emergency contact person, allowing sips of water, allowing oral liquids after 2 days, and discharging on NJ Feeds while continuing PPI and reviewing in a week. The initial management of the patient focused on stabilizing his clinical condition and preventing further injury to the GI tract. The use of NJ tube feeding is a common approach in the management of acid ingestion cases. It helps in bypassing the injured mucosa and delivering the necessary nutrition and medication to the small intestine, minimizing the risk of aspiration and further damage to the injured esophagus and stomach ( 3 ). The use of pantoprazole, a proton pump inhibitor, helps in reducing the acidity of the gastric juice, preventing further injury to the mucosa, and promoting healing ( 4 ). The monitoring of the patient's vitals and input/output chart is essential to detect any signs of complications, such as dehydration, electrolyte imbalances, or abdominal distension. CASE REPORT A 7-year-old boy was brought to a tertiary care hospital after accidentally ingesting a mixture of sulfuric acid and water at midnight, followed by four episodes of vomiting containing blood. The patient was admitted for further care and management. The birth history indicated a LSCS delivery, and the child weighed 2.5 kgs at birth. Systemic examination revealed a normal cardiovascular system, a normal respiratory system, and a dull and lethargic nervous system. The physician's plan included marking a Naso-jejunal Tube at the nasal end, administering slow boluses over 20 minutes, monitoring for abdominal distension and pain, stopping IVF after 2 hours of starting NJ feeds, continuing injection pantoprazole, and monitoring vitals and strict I/O chart. The plan also included informing SOS, allowing sips of water, allowing oral liquids after 2 days. On day two, there were no active bleeds or complaints of abdominal pain, and the child was on NJ tube. The heart rate was 101 beats/min, the respiratory rate was 20 min, and the SpO2 was 99% with room air. The plan included stopping feeds, restarting IVF DNS @35ml/hr, confirming X-ray with GI, administering injection Ceftriaxone, pantoprazole, paracetamol, and ondansetron, and administering syrup mucaine gel and syrup taxim O forte. Serum electrolytes were scheduled for the next day, and a GI review was planned. On day three, the child was on NJ feeding 50 ml/hourly, there were no issues overnight, and the vitals were normal. The diet chart was followed, trace electrolytes were checked, and the position of the NJ tube was confirmed. The dietician suggested increasing the feeding rate to 80ml/hour, increasing calories by 20%, and adding 1 gram of salt. The patient was mobilized and shifted to the general ward. On days four and five, the vitals were stable, and the same treatment was advised. The plan was to monitor vitals and inform SOS. The consultant advised allowing small quantities of liquid banana milkshake per oral in small quantities with intervals of 2 hours. On day six, the vitals were stable, and the same treatment was advised. The patient's oral intake, urinary output, and hydration were moderate, and trace coagulation report was reviewed. The patient was discharged with the NJ tube and advised to follow a diet as per dietician advice, taking small quantities of banana milkshake orally every 2 hours, taking syrup taxim forte, syrup mucaine gel, and tab pantoprazole twice daily for 7 days. The NJ tube was to be administered twice daily for 7 days. The patient was hemodynamically stable, afebrile, and active at the time of discharge. The discharge summary included details of the patient's condition at the time of admission, treatment, and discharge advice. Discharge summary: The following is the case report of a 7-year-old male child who was brought to the hospital with a history of accidental ingestion of sulfuric acid diluted with water, followed by four episodes of hematemesis. The patient was admitted to the Pediatric Intensive Care Unit (PICU) for further management after initial counseling and consenting. Upon examination, the patient was afebrile with a heart rate of 128 beats per minute, respiratory rate of 22 minutes, SpO2 of 100% on room air, and a normal cardiovascular system. The central nervous system was dull and lethargic, with a Glasgow Coma Scale (GCS) of 15/15. The chest had bronchial artery embolization and the endoscopy report showed a linear burn in the upper 2/3 and lower 1/3 of the esophagus, circumferential superficial burn with whitish mucosa, normal GE junction, and superficial burn with patch of black mucosa in greater curvature of the stomach. The patient was started on IV antibiotics (Ceftriaxone), IV antacid, and other supportive management. Point of care investigations were sent, and baseline labs were normal. The patient tolerated the endoscopy procedure well and was advised to start NJ tube feeding. The patient was hemodynamically stable and accepting orally well and was shifted to the ward for further care and management. In the ward, the patient was regularly monitored, and his vitals were stable. The patient's representative was educated about the technique of feeding the NJ tube and felt confident in doing so. The patient was discharged on medical advice, with a condition of being hemodynamically stable, afebrile, and active with HR-108/min, RR-24/min, SpO2 100%, Langs-BAE, and stable vitals. The patient was discharged with advice to follow a diet as per the dietician's recommendations, with hourly NJ tube feeding and small quantities of banana milkshake orally every two hours. The patient was also prescribed Syp Taxim O Forte 4L through the NJ tube twice daily for 7 days, Tab Pantoprazole 20 mg once daily through the NJ tube for 7 days, and Syp Mucaine Gel 5 ml orally through the mouth thrice daily for 7 days. The NJ feeding tube care was advised, and Syp P 250 4 ml was prescribed SOS for fever if the temperature was above 99.5°F. The patient was advised to review after 7 days and to follow up immediately if there were persistent fever above 101°F, shortness of breath, difficulty breathing, persistent loose stools/vomiting, dull activity, decreased oral intake, or decreased urine output. DISCUSSION Esophageal burns caused by acid ingestion are rare but potentially fatal, especially in children. The severity of injury depends on several factors, including the concentration and amount of acid ingested, the duration of contact with the esophagus, and the presence of other medical conditions. Sulphuric acid is a strong mineral acid that can cause significant tissue damage by dehydrating and coagulating the proteins in the esophageal lining, leading to coagulation necrosis and ulceration (Lupa et al., 2009). The resulting scarring and strictures can lead to dysphagia, obstruction, and other complications (Mowry et al., 2012). The management of esophageal burns caused by acid ingestion requires prompt assessment, resuscitation, and stabilization of the patient. The initial management includes airway management, oxygen therapy, and monitoring of vital signs. Endoscopy is a crucial diagnostic tool that helps assess the extent and severity of the injury and guides the management plan. Endoscopic findings may include erythema, erosions, ulcerations, stricture formation, or perforation, depending on the degree of injury (Spiegel et al., 2014). The management of esophageal burns may involve several treatment modalities, including pharmacotherapy, endoscopic dilation, surgical intervention, and nutritional support. Pharmacotherapy aims to reduce acid secretion, relieve pain and inflammation, and prevent infection. Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) are commonly used to reduce gastric acid secretion and promote healing (Mowry et al., 2012). Sucralfate, a mucosal protectant, forms a physical barrier over the ulcers and promotes healing by stimulating prostaglandin synthesis (Mowry et al., 2012). Antibiotics may be necessary in cases of infection or suspected bacterial translocation (Cohen et al., 2016). Endoscopic dilation is a minimally invasive technique used to relieve strictures caused by esophageal burns. It involves the insertion of a balloon or bougie into the esophagus and gradually increasing the diameter of the stricture (Spiegel et al., 2014). Multiple sessions may be required to achieve optimal results, and the risk of perforation should be carefully monitored. Surgical intervention may be necessary in cases of severe injury, perforation, or refractory strictures. The surgical options include esophagectomy, colonic interposition, or jejunal interposition, depending on the extent and location of the injury (Spiegel et al., 2014). Nutritional support is essential in patients with esophageal burns, especially those with dysphagia or strictures. Enteral nutrition is the preferred method of feeding and can be achieved through nasogastric (NG) or Naso jejunal (NJ) tubes. NJ tube feeding is preferred over NG tube feeding in patients with severe esophageal burns or strictures, as it reduces the risk of aspiration and provides better nutrition delivery ( 12 ). In this case, the patient was started on NJ tube feeding following endoscopy which revealed a superficial burn with patch of black mucosa in greater curvature and erythema and friability all over the stomach. Dietician opinion was sought, and feeding was initiated with no complaints of vomiting or abdominal pain. The patient's representative was also educated about the technique of feeding through the NJ tube and was confident in administering it. The patient improved symptomatically with good oral intake and was discharged with advice to continue NJ tube feeding, along with medication for pain relief and acid suppression, and to follow up after 7 days. In the management of patients with toxic ingestions, clinical pharmacists play an essential role in optimizing pharmacotherapy and reducing medication-related adverse events. In this case report, the clinical pharmacist was actively involved in the patient's management, providing medication counseling and monitoring drug interactions and adverse effects. Clinical pharmacists are uniquely trained to evaluate medication appropriateness, recommend dose adjustments, and ensure medication safety, particularly in patients with altered pharmacokinetics and pharmacodynamics due to organ dysfunction or drug toxicity. Several studies have highlighted the role of clinical pharmacists in improving medication safety and optimizing pharmacotherapy in patients with toxic ingestions. A retrospective study by Kim et al. showed that the involvement of a clinical pharmacist in the management of patients with acute poisonings significantly reduced the incidence of medication errors and improved patient outcomes (Kim et al., 2016). Similarly, a study by Tran et al. demonstrated that pharmacist involvement in the management of patients with acetaminophen overdose led to a decrease in hospital length of stay and improved the timely administration of antidotes (Tran et al., 2015). In summary, the active involvement of a clinical pharmacist in the management of patients with toxic ingestions, such as the case described in this report, can improve medication safety, optimize pharmacotherapy, and improve patient outcomes. CONCLUSION In conclusion, this case report highlights the rare and potentially fatal complication of caustic esophageal stricture following the ingestion of a household cleaning agent. The management of caustic ingestion requires a multidisciplinary approach, including gastroenterologists, surgeons, nutritionists, and clinical pharmacists, to optimize patient outcomes. Early recognition and prompt intervention are essential in patients with caustic ingestion, as delayed management can result in severe complications, such as strictures or perforation. In this case, the patient underwent multiple endoscopic interventions, including dilation and stent placement, to manage the esophageal strictures. In addition, nutritional support and enteral feeding were provided to prevent malnutrition and maintain adequate caloric intake. Clinical pharmacists play a vital role in the management of patients with toxic ingestions, providing medication counseling, monitoring drug interactions, and optimizing pharmacotherapy. In this case, the clinical pharmacist was actively involved in the patient's management, ensuring medication safety and appropriate dosing. Overall, the successful management of caustic esophageal strictures requires a collaborative effort from a multidisciplinary team, including early recognition, prompt intervention, and ongoing monitoring. With appropriate management, patients with caustic ingestion can achieve favorable outcomes and maintain a good quality of life. This case underscores the importance of caution when handling household cleaning agents and the need for public education regarding the hazards of caustic ingestion. Declarations Ethics approval and consent to participate: This case report is exempt from institutional review. Per our institutional guidelines, case reports of three or fewer patients do not require institutional review board approval. Written/ Verbal consent was obtained from the patient. Consent for publication: Written/ Verbal consent to publish his data was obtained from the patient. Funding: Not Applicable Author Contribution All authors reviewed the manuscript. References World Health Organization. Burns. https://www.who.int/news-room/fact-sheets/detail/burns Abbasi, H., Dehghani, A., Mohammadi, A. A., Ghadimi, T., & Keshavarzi, A. (2021). The Epidemiology of Chemical Burns Among the Patients Referred to Burn Centers in Shiraz, Southern Iran, 2008-2018. Bulletin of emergency and trauma, 9(4), 195–200. https://doi.org/10.30476/BEAT.2021.90754.1261 Palao, R., Monge, I., Ruiz, M., & Barret, J. P. (2010). Chemical burns: pathophysiology and treatment. Burns : journal of the International Society for Burn Injuries, 36(3), 295–304. https://doi.org/10.1016/j.burns.2009.07.009 Kamat, R., Gupta, P., Reddy, Y. R., Kochhar, S., Nagi, B., & Kochhar, R. (2019). Corrosive injuries of the upper gastrointestinal tract: A pictorial review of the imaging features. The Indian journal of radiology & imaging, 29(1), 6–13. https://doi.org/10.4103/ijri.IJRI_349_18 De Lusong, M. A. A., Timbol, A. B. G., & Tuazon, D. J. S. (2017). Management of esophageal caustic injury. World journal of gastrointestinal pharmacology and therapeutics, 8(2), 90–98. https://doi.org/10.4292/wjgpt.v8.i2.90 Dries, D. J., & Marini, J. J. (2017). Management of Critical Burn Injuries: Recent Developments. Korean journal of critical care medicine, 32(1), 9–21. https://doi.org/10.4266/kjccm.2016.00969 Khongwar, D., Hajong, R., Saikia, J., Topno, N., Baruah, A. J., & Komut, O. (2016). Clinical study of burn patients requiring admission: A single center experience at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences. Journal of family medicine and primary care, 5(2), 444–448. https://doi.org/10.4103/2249-4863.192337 Gupta, V., Shah, J., Yadav, T. D., Kumar, P., Wig, J. D., & Kochhar, R. (2023). Emergency surgical intervention in acute corrosive ingestion: single-center experience from India. ANZ journal of surgery, 93(12), 2864–2869. https://doi.org/10.1111/ans.18576 Dewanti, S., & Kholili, U. (2022). Acute management of caustic injury patient in low-resource settings. International journal of surgery case reports, 92, 106871. https://doi.org/10.1016/j.ijscr.2022.106871 Żwierełło, W., Piorun, K., Skórka-Majewicz, M., Maruszewska, A., Antoniewski, J., & Gutowska, I. (2023). Burns: Classification, Pathophysiology, and Treatment: A Review. International journal of molecular sciences, 24(4), 3749. https://doi.org/10.3390/ijms24043749 Behera, C., Chopra, S., Garg, A., & Kumar, R. (2016). Sulphuric acid marketed in water bottle in India: A cause for fatal accidental poisoning in an adult. The Medico-legal journal, 84(2), 97–100. https://doi.org/10.1177/0025817216629857 Findlay, M., Purvis, M., Venman, R., Luong, R., & Carey, S. (2020). Nutritional management of patients with oesophageal cancer throughout the treatment trajectory: benchmarking against best practice. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 28(12), 5963–5971. https://doi.org/10.1007/s00520-020-05416-x Kaleemuddin Mohammed , Sankham Rajendran D , Bhojraj Suresh , (2001), The Role of the Clinical Pharmacist in Poison-Related Admissions in a Secondary Care Hospital, The Australian Journal of Hospital Pharmacy, 31, https://doi.org/10.1002/jppr200131126 Albert, K., Wilson, K., & Hasara, S. (2023). Implementation of a pharmacist toxicology service on treatment of paracetamol (acetaminophen) overdose. Clinical toxicology (Philadelphia, Pa.), 61(3), 162–165. https://doi.org/10.1080/15563650.2022.2164296 Routsolias, J. C., Gimbar, R. P., & Zell-Kanter, M. (2020). Clinical Pharmacists: Essential During a Poison Outbreak. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 16(4), 356–357. https://doi.org/10.1007/s13181-020-00793-5 Dagnew, S. B., Binega Mekonnen, G., Gebeye Zeleke, E., Agegnew Wondm, S., & Yimer Tadesse, T. (2022). Clinical Pharmacist Intervention on Drug-Related Problems among Elderly Patients Admitted to Medical Wards of Northwest Ethiopia Comprehensive Specialized Hospitals: A Multicenter Prospective, Observational Study. BioMed research international, 2022, 8742998. https://doi.org/10.1155/2022/8742998 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5814960","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":425238780,"identity":"3295e9d4-5fae-45a7-836b-63068746f781","order_by":0,"name":"Mohammed Misbah Ul Haq","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYDCCAwwMEgwGDAkMEsxAJoMFAwMP8VrYEhgYEiSI1cIA0sJjQJwWvtunE2/dKKjL45/d8/Ex7w8JOX6eA4wfPubg1iJ5LnezdY7B4WKJO2c3G/MkSBhL9jYwS87chluLwRnebdI5BgcSG27kbpMGaknccJ6BjZmXsJa6xPk3cp6RpIU5ccONHDaIlrMN+LVInuGF+MXwRpqx4Zw0oF96Djbj9QvfGd6Nt3P+1OXJ3Uh++OCNjQ0wxJIPfviIRws2wNhAmvpRMApGwSgYBRgAAH9hUNZasrL4AAAAAElFTkSuQmCC","orcid":"","institution":"Deccan School of Pharmacy","correspondingAuthor":true,"prefix":"","firstName":"Mohammed","middleName":"Misbah Ul","lastName":"Haq","suffix":""},{"id":425238781,"identity":"eb82b239-91ef-4f71-9a4f-ef7b9815afcd","order_by":1,"name":"Mohammed Ansar","email":"","orcid":"","institution":"Deccan School of Pharmacy","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"","lastName":"Ansar","suffix":""},{"id":425238782,"identity":"3455d036-81b5-4a09-8e6c-6fc67788e5b8","order_by":2,"name":"Aieman Siddiqua","email":"","orcid":"","institution":"Deccan School of Pharmacy","correspondingAuthor":false,"prefix":"","firstName":"Aieman","middleName":"","lastName":"Siddiqua","suffix":""},{"id":425238783,"identity":"59cb40d1-0e3a-4bda-a982-8cf82db7ca39","order_by":3,"name":"Mohd Mudaseer","email":"","orcid":"","institution":"Deccan School of Pharmacy","correspondingAuthor":false,"prefix":"","firstName":"Mohd","middleName":"","lastName":"Mudaseer","suffix":""}],"badges":[],"createdAt":"2025-01-12 17:53:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5814960/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5814960/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78339684,"identity":"e704647d-92a6-48b7-b633-57477aa81a73","added_by":"auto","created_at":"2025-03-12 08:33:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":337050,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5814960/v1/645d496c-fa7f-46d3-99a9-c59f2e794fa8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eNasojejunal Tube Feeding And Clinical Pharmacy Intervention In The Management of Caustic Esophageal Injury: A Case Report\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eAcid ingestion is a significant medical emergency that can cause severe damage to the gastrointestinal (GI) tract and other organ systems. Accidental ingestion of caustic substances is common in children and can lead to life-threatening injuries, such as perforation, strictures, and even death. Sulfuric acid is a strong mineral acid that is commonly used in various industrial processes and laboratories. It is highly corrosive and can cause severe injuries upon ingestion. Therefore, it is crucial to manage such cases promptly and effectively to prevent long-term complications and improve the patient's outcome.\u003c/p\u003e \u003cp\u003eThe incidence of accidental acid ingestion among children is high, and it is estimated that approximately 6% of all pediatric poisoning cases are due to caustic substances ingestion (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Younger children are at a higher risk of such accidents due to their curiosity and oral exploration behavior. Moreover, children with cognitive or developmental disabilities are also at a higher risk of accidental poisoning. Ingestion of sulfuric acid can cause immediate damage to the mucosa of the oral cavity, esophagus, and stomach. The degree of damage depends on the concentration and volume of the ingested acid, as well as the duration of exposure. The immediate symptoms include pain, drooling, dysphagia, vomiting, hematemesis, and respiratory distress. In severe cases, shock, cardiac arrest, and death may occur.\u003c/p\u003e \u003cp\u003eThe management of acid ingestion involves rapid assessment of the patient's airway, breathing, and circulation, followed by stabilization and decontamination of the gastrointestinal tract. Endoscopy is a crucial tool in the evaluation and management of acid ingestion cases. It helps in assessing the extent and severity of the mucosal injury, identifying the presence of strictures or perforations, and guiding the appropriate treatment. The timing of endoscopy depends on the patient's clinical condition and the severity of the injury. Early endoscopy is recommended for patients with a high risk of severe injury, such as those with a history of caustic ingestion with significant symptoms, such as dysphagia, chest or abdominal pain, and hematemesis or melena (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the case presented, a 7-year-old boy was brought to the hospital after accidentally ingesting a mixture of sulfuric acid and water. The patient had four episodes of vomiting containing blood, and a systemic examination revealed a normal cardiovascular and respiratory system, but a dull and lethargic nervous system. The patient was admitted for further care and management, and the physician's plan included marking a Naso-jejunal Tube (NJ) at the nasal end, administering slow boluses over 20 minutes, monitoring for abdominal distension and pain, stopping intravenous fluids after 2 hours of starting NJ feeds, continuing injection pantoprazole, and monitoring vitals and strict input/output chart. The plan also included informing the emergency contact person, allowing sips of water, allowing oral liquids after 2 days, and discharging on NJ Feeds while continuing PPI and reviewing in a week.\u003c/p\u003e \u003cp\u003eThe initial management of the patient focused on stabilizing his clinical condition and preventing further injury to the GI tract. The use of NJ tube feeding is a common approach in the management of acid ingestion cases. It helps in bypassing the injured mucosa and delivering the necessary nutrition and medication to the small intestine, minimizing the risk of aspiration and further damage to the injured esophagus and stomach (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The use of pantoprazole, a proton pump inhibitor, helps in reducing the acidity of the gastric juice, preventing further injury to the mucosa, and promoting healing (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The monitoring of the patient's vitals and input/output chart is essential to detect any signs of complications, such as dehydration, electrolyte imbalances, or abdominal distension.\u003c/p\u003e"},{"header":"CASE REPORT","content":"\u003cp\u003eA 7-year-old boy was brought to a tertiary care hospital after accidentally ingesting a mixture of sulfuric acid and water at midnight, followed by four episodes of vomiting containing blood. The patient was admitted for further care and management. The birth history indicated a LSCS delivery, and the child weighed 2.5 kgs at birth. Systemic examination revealed a normal cardiovascular system, a normal respiratory system, and a dull and lethargic nervous system. The physician's plan included marking a Naso-jejunal Tube at the nasal end, administering slow boluses over 20 minutes, monitoring for abdominal distension and pain, stopping IVF after 2 hours of starting NJ feeds, continuing injection pantoprazole, and monitoring vitals and strict I/O chart. The plan also included informing SOS, allowing sips of water, allowing oral liquids after 2 days.\u003c/p\u003e \u003cp\u003eOn day two, there were no active bleeds or complaints of abdominal pain, and the child was on NJ tube. The heart rate was 101 beats/min, the respiratory rate was 20 min, and the SpO2 was 99% with room air. The plan included stopping feeds, restarting IVF DNS @35ml/hr, confirming X-ray with GI, administering injection Ceftriaxone, pantoprazole, paracetamol, and ondansetron, and administering syrup mucaine gel and syrup taxim O forte. Serum electrolytes were scheduled for the next day, and a GI review was planned.\u003c/p\u003e \u003cp\u003eOn day three, the child was on NJ feeding 50 ml/hourly, there were no issues overnight, and the vitals were normal. The diet chart was followed, trace electrolytes were checked, and the position of the NJ tube was confirmed. The dietician suggested increasing the feeding rate to 80ml/hour, increasing calories by 20%, and adding 1 gram of salt. The patient was mobilized and shifted to the general ward.\u003c/p\u003e \u003cp\u003eOn days four and five, the vitals were stable, and the same treatment was advised. The plan was to monitor vitals and inform SOS. The consultant advised allowing small quantities of liquid banana milkshake per oral in small quantities with intervals of 2 hours. On day six, the vitals were stable, and the same treatment was advised. The patient's oral intake, urinary output, and hydration were moderate, and trace coagulation report was reviewed. The patient was discharged with the NJ tube and advised to follow a diet as per dietician advice, taking small quantities of banana milkshake orally every 2 hours, taking syrup taxim forte, syrup mucaine gel, and tab pantoprazole twice daily for 7 days. The NJ tube was to be administered twice daily for 7 days. The patient was hemodynamically stable, afebrile, and active at the time of discharge. The discharge summary included details of the patient's condition at the time of admission, treatment, and discharge advice.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDischarge summary:\u003c/h2\u003e \u003cp\u003eThe following is the case report of a 7-year-old male child who was brought to the hospital with a history of accidental ingestion of sulfuric acid diluted with water, followed by four episodes of hematemesis. The patient was admitted to the Pediatric Intensive Care Unit (PICU) for further management after initial counseling and consenting.\u003c/p\u003e \u003cp\u003eUpon examination, the patient was afebrile with a heart rate of 128 beats per minute, respiratory rate of 22 minutes, SpO2 of 100% on room air, and a normal cardiovascular system. The central nervous system was dull and lethargic, with a Glasgow Coma Scale (GCS) of 15/15. The chest had bronchial artery embolization and the endoscopy report showed a linear burn in the upper 2/3 and lower 1/3 of the esophagus, circumferential superficial burn with whitish mucosa, normal GE junction, and superficial burn with patch of black mucosa in greater curvature of the stomach. The patient was started on IV antibiotics (Ceftriaxone), IV antacid, and other supportive management. Point of care investigations were sent, and baseline labs were normal. The patient tolerated the endoscopy procedure well and was advised to start NJ tube feeding.\u003c/p\u003e \u003cp\u003eThe patient was hemodynamically stable and accepting orally well and was shifted to the ward for further care and management. In the ward, the patient was regularly monitored, and his vitals were stable. The patient's representative was educated about the technique of feeding the NJ tube and felt confident in doing so. The patient was discharged on medical advice, with a condition of being hemodynamically stable, afebrile, and active with HR-108/min, RR-24/min, SpO2 100%, Langs-BAE, and stable vitals.\u003c/p\u003e \u003cp\u003eThe patient was discharged with advice to follow a diet as per the dietician's recommendations, with hourly NJ tube feeding and small quantities of banana milkshake orally every two hours. The patient was also prescribed Syp Taxim O Forte 4L through the NJ tube twice daily for 7 days, Tab Pantoprazole 20 mg once daily through the NJ tube for 7 days, and Syp Mucaine Gel 5 ml orally through the mouth thrice daily for 7 days. The NJ feeding tube care was advised, and Syp P 250 4 ml was prescribed SOS for fever if the temperature was above 99.5\u0026deg;F. The patient was advised to review after 7 days and to follow up immediately if there were persistent fever above 101\u0026deg;F, shortness of breath, difficulty breathing, persistent loose stools/vomiting, dull activity, decreased oral intake, or decreased urine output.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eEsophageal burns caused by acid ingestion are rare but potentially fatal, especially in children. The severity of injury depends on several factors, including the concentration and amount of acid ingested, the duration of contact with the esophagus, and the presence of other medical conditions. Sulphuric acid is a strong mineral acid that can cause significant tissue damage by dehydrating and coagulating the proteins in the esophageal lining, leading to coagulation necrosis and ulceration (Lupa et al., 2009). The resulting scarring and strictures can lead to dysphagia, obstruction, and other complications (Mowry et al., 2012).\u003c/p\u003e \u003cp\u003eThe management of esophageal burns caused by acid ingestion requires prompt assessment, resuscitation, and stabilization of the patient. The initial management includes airway management, oxygen therapy, and monitoring of vital signs. Endoscopy is a crucial diagnostic tool that helps assess the extent and severity of the injury and guides the management plan. Endoscopic findings may include erythema, erosions, ulcerations, stricture formation, or perforation, depending on the degree of injury (Spiegel et al., 2014). The management of esophageal burns may involve several treatment modalities, including pharmacotherapy, endoscopic dilation, surgical intervention, and nutritional support.\u003c/p\u003e \u003cp\u003ePharmacotherapy aims to reduce acid secretion, relieve pain and inflammation, and prevent infection. Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) are commonly used to reduce gastric acid secretion and promote healing (Mowry et al., 2012). Sucralfate, a mucosal protectant, forms a physical barrier over the ulcers and promotes healing by stimulating prostaglandin synthesis (Mowry et al., 2012). Antibiotics may be necessary in cases of infection or suspected bacterial translocation (Cohen et al., 2016).\u003c/p\u003e \u003cp\u003eEndoscopic dilation is a minimally invasive technique used to relieve strictures caused by esophageal burns. It involves the insertion of a balloon or bougie into the esophagus and gradually increasing the diameter of the stricture (Spiegel et al., 2014). Multiple sessions may be required to achieve optimal results, and the risk of perforation should be carefully monitored.\u003c/p\u003e \u003cp\u003eSurgical intervention may be necessary in cases of severe injury, perforation, or refractory strictures. The surgical options include esophagectomy, colonic interposition, or jejunal interposition, depending on the extent and location of the injury (Spiegel et al., 2014).\u003c/p\u003e \u003cp\u003eNutritional support is essential in patients with esophageal burns, especially those with dysphagia or strictures. Enteral nutrition is the preferred method of feeding and can be achieved through nasogastric (NG) or Naso jejunal (NJ) tubes. NJ tube feeding is preferred over NG tube feeding in patients with severe esophageal burns or strictures, as it reduces the risk of aspiration and provides better nutrition delivery (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this case, the patient was started on NJ tube feeding following endoscopy which revealed a superficial burn with patch of black mucosa in greater curvature and erythema and friability all over the stomach. Dietician opinion was sought, and feeding was initiated with no complaints of vomiting or abdominal pain. The patient's representative was also educated about the technique of feeding through the NJ tube and was confident in administering it. The patient improved symptomatically with good oral intake and was discharged with advice to continue NJ tube feeding, along with medication for pain relief and acid suppression, and to follow up after 7 days. In the management of patients with toxic ingestions, clinical pharmacists play an essential role in optimizing pharmacotherapy and reducing medication-related adverse events. In this case report, the clinical pharmacist was actively involved in the patient's management, providing medication counseling and monitoring drug interactions and adverse effects. Clinical pharmacists are uniquely trained to evaluate medication appropriateness, recommend dose adjustments, and ensure medication safety, particularly in patients with altered pharmacokinetics and pharmacodynamics due to organ dysfunction or drug toxicity.\u003c/p\u003e \u003cp\u003eSeveral studies have highlighted the role of clinical pharmacists in improving medication safety and optimizing pharmacotherapy in patients with toxic ingestions. A retrospective study by Kim et al. showed that the involvement of a clinical pharmacist in the management of patients with acute poisonings significantly reduced the incidence of medication errors and improved patient outcomes (Kim et al., 2016). Similarly, a study by Tran et al. demonstrated that pharmacist involvement in the management of patients with acetaminophen overdose led to a decrease in hospital length of stay and improved the timely administration of antidotes (Tran et al., 2015).\u003c/p\u003e \u003cp\u003eIn summary, the active involvement of a clinical pharmacist in the management of patients with toxic ingestions, such as the case described in this report, can improve medication safety, optimize pharmacotherapy, and improve patient outcomes.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn conclusion, this case report highlights the rare and potentially fatal complication of caustic esophageal stricture following the ingestion of a household cleaning agent. The management of caustic ingestion requires a multidisciplinary approach, including gastroenterologists, surgeons, nutritionists, and clinical pharmacists, to optimize patient outcomes. Early recognition and prompt intervention are essential in patients with caustic ingestion, as delayed management can result in severe complications, such as strictures or perforation. In this case, the patient underwent multiple endoscopic interventions, including dilation and stent placement, to manage the esophageal strictures. In addition, nutritional support and enteral feeding were provided to prevent malnutrition and maintain adequate caloric intake. Clinical pharmacists play a vital role in the management of patients with toxic ingestions, providing medication counseling, monitoring drug interactions, and optimizing pharmacotherapy. In this case, the clinical pharmacist was actively involved in the patient's management, ensuring medication safety and appropriate dosing. Overall, the successful management of caustic esophageal strictures requires a collaborative effort from a multidisciplinary team, including early recognition, prompt intervention, and ongoing monitoring. With appropriate management, patients with caustic ingestion can achieve favorable outcomes and maintain a good quality of life. This case underscores the importance of caution when handling household cleaning agents and the need for public education regarding the hazards of caustic ingestion.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate:\u003c/h2\u003e\n\u003cp\u003eThis case report is exempt from institutional review. Per our institutional guidelines, case reports of three or fewer patients do not require institutional review board approval. Written/ Verbal consent was obtained from the patient.\u003c/p\u003e\n\u003ch2\u003eConsent for publication:\u003c/h2\u003e\n\u003cp\u003eWritten/ Verbal consent to publish his data was obtained from the patient.\u003c/p\u003e\n\u003ch2\u003eFunding:\u003c/h2\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eAll authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Burns. https://www.who.int/news-room/fact-sheets/detail/burns\u003c/li\u003e\n\u003cli\u003eAbbasi, H., Dehghani, A., Mohammadi, A. A., Ghadimi, T., \u0026amp; Keshavarzi, A. (2021). The Epidemiology of Chemical Burns Among the Patients Referred to Burn Centers in Shiraz, Southern Iran, 2008-2018. Bulletin of emergency and trauma, 9(4), 195\u0026ndash;200. https://doi.org/10.30476/BEAT.2021.90754.1261\u003c/li\u003e\n\u003cli\u003ePalao, R., Monge, I., Ruiz, M., \u0026amp; Barret, J. P. (2010). Chemical burns: pathophysiology and treatment. Burns : journal of the International Society for Burn Injuries, 36(3), 295\u0026ndash;304. https://doi.org/10.1016/j.burns.2009.07.009\u003c/li\u003e\n\u003cli\u003eKamat, R., Gupta, P., Reddy, Y. R., Kochhar, S., Nagi, B., \u0026amp; Kochhar, R. (2019). Corrosive injuries of the upper gastrointestinal tract: A pictorial review of the imaging features. The Indian journal of radiology \u0026amp; imaging, 29(1), 6\u0026ndash;13. https://doi.org/10.4103/ijri.IJRI_349_18\u003c/li\u003e\n\u003cli\u003eDe Lusong, M. A. A., Timbol, A. B. G., \u0026amp; Tuazon, D. J. S. (2017). Management of esophageal caustic injury. World journal of gastrointestinal pharmacology and therapeutics, 8(2), 90\u0026ndash;98. https://doi.org/10.4292/wjgpt.v8.i2.90\u003c/li\u003e\n\u003cli\u003eDries, D. J., \u0026amp; Marini, J. J. (2017). Management of Critical Burn Injuries: Recent Developments. Korean journal of critical care medicine, 32(1), 9\u0026ndash;21. https://doi.org/10.4266/kjccm.2016.00969\u003c/li\u003e\n\u003cli\u003eKhongwar, D., Hajong, R., Saikia, J., Topno, N., Baruah, A. J., \u0026amp; Komut, O. (2016). Clinical study of burn patients requiring admission: A single center experience at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences. Journal of family medicine and primary care, 5(2), 444\u0026ndash;448. https://doi.org/10.4103/2249-4863.192337\u003c/li\u003e\n\u003cli\u003eGupta, V., Shah, J., Yadav, T. D., Kumar, P., Wig, J. D., \u0026amp; Kochhar, R. (2023). Emergency surgical intervention in acute corrosive ingestion: single-center experience from India. ANZ journal of surgery, 93(12), 2864\u0026ndash;2869. https://doi.org/10.1111/ans.18576\u003c/li\u003e\n\u003cli\u003eDewanti, S., \u0026amp; Kholili, U. (2022). Acute management of caustic injury patient in low-resource settings. International journal of surgery case reports, 92, 106871. https://doi.org/10.1016/j.ijscr.2022.106871\u003c/li\u003e\n\u003cli\u003eŻwierełło, W., Piorun, K., Sk\u0026oacute;rka-Majewicz, M., Maruszewska, A., Antoniewski, J., \u0026amp; Gutowska, I. (2023). Burns: Classification, Pathophysiology, and Treatment: A Review. International journal of molecular sciences, 24(4), 3749. https://doi.org/10.3390/ijms24043749\u003c/li\u003e\n\u003cli\u003eBehera, C., Chopra, S., Garg, A., \u0026amp; Kumar, R. (2016). Sulphuric acid marketed in water bottle in India: A cause for fatal accidental poisoning in an adult. The Medico-legal journal, 84(2), 97\u0026ndash;100. https://doi.org/10.1177/0025817216629857\u003c/li\u003e\n\u003cli\u003eFindlay, M., Purvis, M., Venman, R., Luong, R., \u0026amp; Carey, S. (2020). Nutritional management of patients with oesophageal cancer throughout the treatment trajectory: benchmarking against best practice. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 28(12), 5963\u0026ndash;5971. https://doi.org/10.1007/s00520-020-05416-x\u003c/li\u003e\n\u003cli\u003eKaleemuddin Mohammed , Sankham Rajendran D , Bhojraj Suresh , (2001), The Role of the Clinical Pharmacist in Poison-Related Admissions in a Secondary Care Hospital, The Australian Journal of Hospital Pharmacy, 31, https://doi.org/10.1002/jppr200131126\u003c/li\u003e\n\u003cli\u003eAlbert, K., Wilson, K., \u0026amp; Hasara, S. (2023). Implementation of a pharmacist toxicology service on treatment of paracetamol (acetaminophen) overdose. Clinical toxicology (Philadelphia, Pa.), 61(3), 162\u0026ndash;165. https://doi.org/10.1080/15563650.2022.2164296\u003c/li\u003e\n\u003cli\u003eRoutsolias, J. C., Gimbar, R. P., \u0026amp; Zell-Kanter, M. (2020). Clinical Pharmacists: Essential During a Poison Outbreak. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 16(4), 356\u0026ndash;357. https://doi.org/10.1007/s13181-020-00793-5\u003c/li\u003e\n\u003cli\u003eDagnew, S. B., Binega Mekonnen, G., Gebeye Zeleke, E., Agegnew Wondm, S., \u0026amp; Yimer Tadesse, T. (2022). Clinical Pharmacist Intervention on Drug-Related Problems among Elderly Patients Admitted to Medical Wards of Northwest Ethiopia Comprehensive Specialized Hospitals: A Multicenter Prospective, Observational Study. BioMed research international, 2022, 8742998. https://doi.org/10.1155/2022/8742998\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"sulfuric acid ingestion, Naso-jejunal tube, pediatric gastroenterology, acid-related injuries, child health","lastPublishedDoi":"10.21203/rs.3.rs-5814960/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5814960/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAccidental ingestion of corrosive substances, such as sulfuric acid, is a rare but serious medical emergency, particularly in children. Such incidents can result in significant morbidity, including damage to the gastrointestinal tract, and require prompt and comprehensive management. This case is unique as it demonstrates the successful treatment of a 7-year-old boy who ingested sulfuric acid, providing valuable insights into effective clinical interventions. By documenting this case, we aim to expand the knowledge base for managing complex pediatric corrosive ingestion cases, offering a framework for similar scenarios in future clinical practice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation: \u003c/strong\u003eA 7-year-old boy accidentally ingested a mixture of sulfuric acid and water, presenting with severe vomiting and gastrointestinal bleeding. Upon arrival at the hospital, he was hemodynamically stable but exhibited signs of upper gastrointestinal distress. Initial evaluation included physical examination and imaging to assess the extent of damage. A multidisciplinary approach was adopted, starting with nasojejunal tube feeding to bypass the injured esophagus and ensure adequate nutrition. Medications, including proton pump inhibitors to reduce acid secretion and antibiotics to prevent secondary infections, were administered. The patient's vital signs were closely monitored, and a strict dietary plan was implemented, avoiding irritants and promoting gastrointestinal healing. Endoscopy was deferred to avoid further trauma to the already compromised tissue. Over several weeks, the patient showed significant improvement, with resolution of symptoms and no evidence of complications such as stricture formation or perforation. Follow-up care focused on nutritional recovery, psychological support, and education to prevent similar incidents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis case illustrates the critical importance of early recognition and immediate, targeted interventions in managing pediatric acid ingestion. The combination of nasojejunal feeding, vigilant monitoring, and tailored pharmacological and dietary management contributed to a positive outcome. The successful resolution of this complex case without long-term complications highlights effective strategies that can guide clinicians facing similar challenges. By sharing this case, we aim to contribute to the growing body of evidence on pediatric corrosive ingestion management, ultimately enhancing future clinical practices.\u003c/p\u003e","manuscriptTitle":"Nasojejunal Tube Feeding And Clinical Pharmacy Intervention In The Management of Caustic Esophageal Injury: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-12 08:24:57","doi":"10.21203/rs.3.rs-5814960/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6eb432e1-bfe2-4725-be14-8a173258aca4","owner":[],"postedDate":"March 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-12T08:24:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-12 08:24:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5814960","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5814960","identity":"rs-5814960","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}