1
|
Yusuf F, Abubakar A, Maghfirah D, Heltomi M, Isitua CC. Gastrointestinal mucosal damages caused by ingestion of corrosive substances: A case study of hydrochloric acid and sodium hydroxide. NARRA J 2023; 3:e259. [PMID: 38450338 PMCID: PMC10914044 DOI: 10.52225/narra.v3i3.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/14/2023] [Indexed: 03/08/2024]
Abstract
Ingestion of corrosive substances is most common in children, while in adults causes more severe damages. Massive ingestion of corrosive substances results in severe damage to the gastrointestinal tract and oropharynx if not treated properly. Corrosive substances with pH<2 or >12 can result in severe esophageal damage with either colliquative (alkaline) or coagulative (acidic) necrosis and, at the same time various gastrointestinal injuries could lead to late post-corrosive complications. The aim of the case study was to report the gastrointestinal mucosal damages due to hydrochloric acid (HCl) and sodium hydroxide (NaOH) ingestion. A 55-year-old male patient was presented to the emergency room with a chief complaint of vomiting an hour before admission. Continuous vomiting with a volume of approximately 10-20 cc per vomit. The vomit was initially bluish and turned in to blackish brown over time. Other complaints included nausea, rapid breathing, heartburn, and burning mouth and throat, and had weakness and dizziness. The patient accidentally drank floor cleaning liquid containing HCl. The patient was diagnosed with hematemesis due to ulceration of esophageal, gastric, and duodenal mucosa induced by HCl. Tracheoesophageal fistula developed later in the patient as a long-term complication. Another a 22-year-old male patient was presented to the emergency room with chief complaints of nausea and vomiting an hour before admission. Headache and slight tightness were also experienced. The patient mouth felt burned pain in the solar plexus and frothy saliva. An hour earlier, the patient attempted suicide by drinking two bottles of floor cleaning liquid due to economic problems. The patient was diagnosed with erosive mucosal esophagogastroduodenum induced by NaOH. These cases highlight that intoxication with corrosive substances can complicate damage to the gastrointestinal mucosal and damage features depend on the type of substance concentration and quantity of the corrosive substance.
Collapse
Affiliation(s)
- Fauzi Yusuf
- Division of Gastroenterohepatology, Department of Internal Medicine, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Azzaki Abubakar
- Division of Gastroenterohepatology, Department of Internal Medicine, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Desi Maghfirah
- Division of Gastroenterohepatology, Department of Internal Medicine, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Mirza Heltomi
- Department of Internal Medicine, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Chinwe C. Isitua
- Departement of Biology and Forensic Science, Faculty of Science, Admiralty University of Nigeria, Ibusa, Nigeria
| |
Collapse
|
2
|
Brás Cruz R, David F, Rocha DL, Pereira A, Gomes E. Self-Poisoning With Household Bleach in an Elderly Man. Cureus 2023; 15:e34957. [PMID: 36938176 PMCID: PMC10018575 DOI: 10.7759/cureus.34957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
Caustic self-poisoning is a major health hazard, which affects any age, but is particularly serious among the elderly. Household bleach is a caustic that contains 3% to 6% sodium hypochlorite solution, one of the most common agents in unintentional caustic poisoning. In this clinical case, we present a household bleach self-poisoning by an older man with no relevant medical history. He presented with extensive burns on the oral cavity mucosa and tongue, requiring orotracheal intubation by video laryngoscopy. He was then admitted to the intensive care unit, where he evolved poorly. Given the poor prognosis and the lack of physiological reserve for the invasiveness required for a surgical approach, a conservative strategy was chosen after a multidisciplinary team discussion. With the conservative strategy, the patient survived, being discharged to the general ward after one month, where he underwent a Stamm gastrostomy and placement of a percutaneous endoscopic gastrostomy. In the follow-up consultation three months later, the patient was found to be weakened, with high frailty status, presenting anxiety, depression, and causing high family burden.
Collapse
Affiliation(s)
- Rute Brás Cruz
- Internal Medicine, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, PRT
| | - Filipa David
- Internal Medicine, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, PRT
| | - Diana L Rocha
- Internal Medicine, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, PRT
| | - Adelina Pereira
- Internal Medicine, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, PRT
| | - Ernestina Gomes
- Intensive Care Unit, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, PRT
| |
Collapse
|
3
|
Wojt IR, Lau ECY, Cairns R, Tan ECK. Poisonings in Older People with Dementia: A Systematic Scoping Review and Meta-Analysis. J Alzheimers Dis 2023; 95:1351-1370. [PMID: 37694366 DOI: 10.3233/jad-230246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Older people with dementia are at a particularly high risk of poisonings and their subsequent harms. OBJECTIVE This review aimed to describe the key agents, incidence, risk factors, and disposition of poisonings in people with dementia reported in the literature. METHODS Medline, Embase, CINAHL, and PsycINFO databases were searched from 1 September 2001 to 1 September 2021. Terms for dementia, poisonings, and older adults formed the search concepts. Quantitative studies published in English, describing poisonings in older people with dementia, including Alzheimer's disease, were included. Two investigators independently assessed articles for eligibility and extracted relevant data. A meta-analysis of the incidence of poisonings in people with dementia across studies was performed. RESULTS Of 4,579 articles, 18 were included for final synthesis. Nervous system medications were implicated in over half of all medicinal poisonings, with anti-dementia agents, benzodiazepines, and opioids the most common classes. The non-medicinal agents frequently associated with poisonings were personal care and household products. The yearly incidence of poisoning varied across definitions of poisoning from 3% for International Classification of Disease-defined poisonings to 43% for adverse drug event-defined poisonings. Several risk factors were identified, including multimorbidity, psychotropic medication use, and living in residential care. Where described, up to one in five poisonings resulted in hospitalisation and in death. CONCLUSIONS Poisonings are common in people with dementia, involving commonly prescribed medications or easily accessible substances. Given the significant outcomes associated, further research is required to better understand these poisonings and improve public health strategies to reduce the occurrence of this preventable harm.
Collapse
Affiliation(s)
- Ilsa R Wojt
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Edward C Y Lau
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Rose Cairns
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, New South Wales, Australia
| | - Edwin C K Tan
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Deguigne M, Cellier M, Hamon Y, Legay M, Descatha A. Poisoning exposure from non-pharmaceutical products in residents of structured living facilities. Clin Toxicol (Phila) 2021; 60:371-378. [PMID: 34409905 DOI: 10.1080/15563650.2021.1965158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objectives of this study were to describe poisonings occurring in older or disabled patients residing in structured living facilities, identify risk factors, and propose preventive measures. METHOD This was a prospective and observational study, covering all cases of poisoning occurring in structured living facilities in the Brittany region of France. All calls were received at the Grand Ouest Poison Control Centre (PCC) of Angers and were recorded from 1 February 2019 to 31 January 2020. The clinical severity of the poisonings was assessed using the Poisoning Severity Score (PSS). Clinical severity was compared by univariate and multivariate analyses using the following dependent variables: PSS score < 2 and PSS ≥ 2. RESULTS This study included 158 residents with a median age of 83 years (5-116 years old). The average number of residents supervised by a member of the supervisory staff was 11 (+/-10.7). The substance ingested was a personal hygiene product or a cleaning product in 48% and 25% of cases, respectively. The most frequently ingested product was a bar of soap (n = 20). All moderate to severe cases (4.6%, n = 8 including one death) occurred in residents with dementia living in nursing homes for elderly patients, and 9% of residents required hospital treatment. In more than 50% of cases (n = 83), the product was provided by the facility and in 23% (n = 40), it was brought in by the family. Ingestion of a bar of soap or a product brought in by the family was significantly associated with higher poisoning severity (PSS ≥ 2). After adjustment for age, sex and the number of residents per supervisor, the severity of poisoning was significantly greater after ingestion of a bar of soap (OR = 12.33, CI95 [2.12, 71.63], p = 0.005). CONCLUSION Older adults residing in medical facilities who have a history of dementia and/or cognitive impairment are more at risk of non-medicinal product poisoning. Clinical severity and the hospitalisation rate were greater when bar soap was ingested.
Collapse
Affiliation(s)
- Marie Deguigne
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - Morgane Cellier
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - Yveline Hamon
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - Marion Legay
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - Alexis Descatha
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France.,Univ Angers, CHU Angers, Univ Rennes, Inserm, Ehesp, Irset (Institut de recherche en santé, environnement et travail - Research Institute for Environmental and Occupational Health), Angers, France
| |
Collapse
|
5
|
Ain QU, Jamil M, Safian HA, Akhter TS, Batool S, Arshad M, Jamal AM, Iqbal A, Arsh L, Abbas B. Assessing the Degree of Acute Esophageal Injury Secondary to Corrosive Intake: Insights From a Public Sector Hospitals of a Developing Country. Cureus 2020; 12:e10858. [PMID: 33178511 PMCID: PMC7652017 DOI: 10.7759/cureus.10858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Caustic ingestion continues to be a significant problem worldwide especially in developing countries and particularly in the age group of under six years. Ingestion of caustic substances is a medical emergency in both the adult and pediatric population and is associated with high morbidity and mortality. The ingestion of caustic substances induces an extensive spectrum of injuries to the aerodigestive tract, which includes extensive necrosis and perforation of the esophagus and stomach. Objectives The main aims were to determine upper and lower esophageal injuries associated with corrosive intake and to compare esophageal injury with age and gender. Rationale Once we’ll find the extent and severity of esophageal injury associated with corrosive intake within 24 hours, we’ll be able to manage the case timely and to limit further complications and disabilities. Materials and Methods This descriptive cross-sectional study was conducted on 150 patients who presented with corrosive ingestion and underwent urgent endoscopic evaluation. Data were collected using self-designed pro forma. Endoscopic findings were classified according to the Zargar classification. A descriptive analysis of study variables was performed using SPSS v.21.0 (IBM Corp., Armonk, NY, USA). The chi-square test was used, and a p-value of less than 0.05 was considered statistically significant. Results Out of 150 patients under study, 103 (68.7%) were females and 47 (31.3%) were males. The most prevalent age group presenting with corrosive intake was found to be between 21 and 34 years of age (43.3%) in both genders. The most common part of the esophagus prone to corrosive insult is the upper esophagus (99.3%), whereas, regarding severity, the lower esophagus has more severe injuries (predominant being stage 2B, i.e., 32%). There are no statistically significant differences in esophageal injuries in different age groups (upper esophageal injury: 0.319; lower esophageal injury: 0.696) and genders (upper esophageal injury: 0.769; lower esophageal injury: 0.752). Conclusions Most of the patients under study belong to the female gender and teen and younger age group. The predominant upper esophageal injury as a result of corrosive intake is stage 0 injury, and the least common is found to be stage 1 injury. The predominant lower esophageal injury as a result of corrosive intake is stage 2B injury, whereas the least common is found to be stage 4 injury.
Collapse
Affiliation(s)
- Qurat Ul Ain
- Psychology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Manahil Jamil
- Psychology, Rawalpindi Medical University, Rawalpindi, PAK
| | | | | | - Salma Batool
- Psychology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Moniba Arshad
- Psychology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Ali Murad Jamal
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Ather Iqbal
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Laraib Arsh
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Bilawal Abbas
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| |
Collapse
|
6
|
Hall AH, Jacquemin D, Henny D, Mathieu L, Josset P, Meyer B. Corrosive substances ingestion: a review. Crit Rev Toxicol 2020; 49:637-669. [PMID: 32009535 DOI: 10.1080/10408444.2019.1707773] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Corrosive chemical substance ingestions are a major problem, especially in developing countries, but also in developed countries such as the United States, France, and Belgium. Ingestions may be deliberate as suicide attempts (mostly in adolescents and adults) or accidental (mostly in children). The results can be devastating in terms of individual suffering and disability, but also in terms of resource utilization and costs. In developing countries, outcomes may be worse because of limited medical/surgical resources. Common sequelae include gastrointestinal (GI) tract (esophagus, stomach, pylorus, and duodenum) stricture formation, GI tract perforation, and hemorrhage. Systemic effects may also occur, such as disseminated intravascular coagulation (DIC), multi-organ system failure, and sepsis. Various interventions in the acute phase to reduce the severity of injury have been attempted, but there are no large controlled clinical trials to demonstrate efficacy. Dilation therapy in various forms is commonly used for the treatment of strictures and a variety of surgical procedures including esophagectomy and delayed replacement may be required in severe corrosive injury cases.
Collapse
Affiliation(s)
- Alan H Hall
- Toxicology Consulting and Medical Translating Services, Azle and Springtown, TX, USA.,Colorado School of Public Health, University of Colorado-Denver, Denver, CO, USA
| | | | | | | | - Patrice Josset
- Department of Pathology, Hôpital d'Enfants Armand Trousseau, Director of the Teaching Program of the History of Medicine, Université Pierre et Marie Curie, Paris, France
| | - Bernard Meyer
- Department of Otorhinolaryngology, Université Pierre et Marie Curie, Groupe Hospitalier Pieté-Salpêtrière, Paris, France
| |
Collapse
|
7
|
Acehan S, Satar S, Gulen M, Avci A. Evaluation of corrosive poisoning in adult patients. Am J Emerg Med 2020; 39:65-70. [PMID: 31982223 DOI: 10.1016/j.ajem.2020.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/04/2019] [Accepted: 01/07/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To evaluate the demographic characteristics, endoscopy results, emerging complications and the final status of caustic intake cases admitted to our emergency department. METHOD This study is a retrospective one concerning patients admitted to our emergency department due to caustic ingestion. Demographic characteristics of the patients, complaints while applying to the hospital, physical examination findings, the purpose of caustic intake, the characteristics of corrosive substance taken, times of endoscopy following admission to the emergency department, follow-up times in the emergency department, endoscopic staging and outcome. The data were analyzed through IBM SPSS Statistics Base 22.0 package program. RESULTS Seventy four patients participated in the study. 83.8% of corrosive substance intake cases were accidental and 16.2% cases were suicidal intention. While 60.8% of the corrosive substances taken had alkaline property, 36.5% were acidic and 2.7% were found to be unknown substances. 50% of the corrosive substance intakes were sodium hypochlorite. It was seen that endoscopy was performed in 59 patients who accepted endoscopy within an average of 244.07 min after admission to the emergency department. While no damage could be seen in 55.9% of patients following endoscopy, the most common injury was Grade 1 (35.6%). CONCLUSION Corrosive substance intake is a rare but potentially devastating poisoning with high morbidity and mortality. Mucosal injury begins within minutes following corrosive intake. Therefore, early endoscopy is helpful in assessing the degree of injury and early discharge from hospital.
Collapse
Affiliation(s)
- Selen Acehan
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey.
| | - Salim Satar
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Muge Gulen
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Akkan Avci
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| |
Collapse
|
8
|
Hashmi MU, Ali M, Ullah K, Aleem A, Khan IH. Clinico-epidemiological Characteristics of Corrosive Ingestion: A Cross-sectional Study at a Tertiary Care Hospital of Multan, South-Punjab Pakistan. Cureus 2018; 10:e2704. [PMID: 30062078 PMCID: PMC6063384 DOI: 10.7759/cureus.2704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Corrosive ingestion is a grave public health problem. It is a medical emergency and shows diverse clinical presentations. The ingestion of corrosive substances has devastating effects on upper gastrointestinal and respiratory tracts and the corrosive injury is associated with numerous life-threatening complications. The present study aims to explore the clinico-epidemiological characteristics of patients of corrosive ingestion presenting at a tertiary care hospital of Multan, Pakistan. Method The target study population consists of all the patients with primary diagnosis of corrosive ingestion who presented to the department of thoracic surgery, Nishtar Medical University Hospital Multan, Pakistan, from January 2016 to December 2017. The follow-up cases and the cases with ingestion of substances other than corrosives were not included in the study. All the included cases were evaluated by detailed history, thorough physical examination and the necessary investigations. The post-cor-rosive tissue damage was classified accord-ing to Zargar's classification system. All the demographic data and other variables were measured and recorded using a Performa. The data were analyzed by using computer program SPSS 21 version. Results The total study population was 206 patients. There were 135 females (65.5%) and 71 male patients (34.5%). Age ranged from 2 to 42 years (mean 23.44 ± 7.19). Only seven cases were found in the age group of 2-7 years. The residents of rural areas showed a slightly increased inclination towards corrosive ingestion. One hundred and ten cases were unmarried (53.4%) while 90 patients were married (43.7%). The incidence of corrosive ingestion was much high in illiterate/less educated patients belonging to the groups of lower socio-economic status. One hundred and ninety-seven patients ingested corrosive substances deliberately with the suicidal intention (95.6%). The acid used as bathroom cleaner and the laundry bleaches were the most commonly used corrosive agents. In 166 cases the corrosive materials were already present at home for domestic purposes (80.6%), but 18 subjects particularly purchased these corrosive substances to commit suicide. The quantity of ingested material ranged between 10 ml and 150 ml with a mean of 42.6 ml ± 33.2. The shortest hospital stay was one day, and the longest one was 60 days. Esophagus and oropharyngeal area were the most common site which sustained the corrosive injury, whereas corrosive injury to duodenum was least frequent (34.5 %). Conclusion Corrosive ingestion is a serious medical problem and it requires a multidisciplinary approach and a good coordination between different medical specialists. Underprivileged teenager females of rural areas are more likely to ingest corrosive materials with suicidal intention. In most of the ingestions, household cleaning products are used. Only the patients with severe corrosive injury should be admitted to intensive care units. Enforcing regulations for the manufacturers of household cleaning products can significantly reduce the incidence of this potentially fatal condition.
Collapse
Affiliation(s)
| | - Mansoor Ali
- Thoracic Surgery, Nishtar Medical University Hospital, Multan, PAK
| | - Kaleem Ullah
- Upper Gi and Thoracic Surgery, Nishtar Medical University Hospital, Multan, PAK
| | - Abdul Aleem
- Thoracic Surgery, Nishtar Medical University Hospital, Multan, PAK
| | - Iftikhar H Khan
- Thoracic and General Surgery, Nishtar Medical University, Multan, PAK
| |
Collapse
|