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. 2002 Aug 31;325(7362):496.

Acid, burns, and feeding tubes

Patients should not be allowed to lie in their own vomit: gastric acid burns

C M Danbury 1
PMCID: PMC1124013  PMID: 12202342

Editor—I dispute the recommendation of Lapsia and Maguire in Minerva that “patients fed via a nasogastric tube should take a gastric protecting agent” on the basis of their finding of chemical burns in a patient who vomited after nasogastric feeding on a neurological ward.1

graphic file with name danburc.f1.jpg

CINTI/CNRI/SCIENCE PHOTO LIBRARY

Anyone without achlorhydria secretes hydrogen ions from gastric mucosa whether fed orally, by a nasogastric tube, or parenterally. Thus during vomiting, acid is likely to come into contact with the skin. If we follow the authors' advice anyone capable of vomiting acid would be prescribed a gastric protecting agent.

The authors note that nurses reported that the patient in their case had vomited previously and that during the morning ward round “there was evidence of fresh vomit on her sheets.” This implies that she had been in contact with her vomit for some time.

I suggest that a more logical conclusion for the authors to have drawn is that patients should not be allowed to lie in their own vomit.

References

  • 1.Lapsia S, Maguire S. Minerva. BMJ. 2002;324:1404. . (8 June.) [Google Scholar]
BMJ. 2002 Aug 31;325(7362):496.

Summary of rapid responses

Sharon Davies 1

We published six electronic responses making similar points about this picture report in Minerva, as well as an apology from Minerva for allowing the report to be published without the corroboration of peer review.1-1

Correspondents offered pithy conclusions, including “patients being fed via a nasogastric tube should be properly nursed” (Kevin Booth) and “drugs are not a substitute for quality nursing care” (Michael Terry).

Tim Palfreman and Nicholas Lavies reiterated that the burns had nothing to do with acid suppression or nasogastric feeding: “To suggest otherwise is at best an elementary failure to think straight.” They gave the last word to J B S Haldane, who said in 1939: “We are told the most fantastic biological tales. For example, that it is dangerous to have acid in your stomach.”

References

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