ACUTE POISONINGS WITH CORROSIVE SUBSTANCES – NEW FINDINGS AND REVIEW OF OUR FIVE-YEAR MATERIAL

Authors

  • Andon Chibishev University Clinic for Toxicology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
  • Emilija Shikole Institute of Preclinical and Clinical Pharmacology with Toxicology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
  • Vesna Chibisheva University Clinic for Obstetrics and Gynecology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
  • Martina Savovska Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia

Keywords:

corrosive intoxications, endoscopy, esophageal strictures

Abstract

Ingestion of corrosive chemical substances remains a serious problem in modern clinical toxicology due to its high mortality rate in the acute phase and the risk of serious, long-term complications during the chronic phase.

Findings in this study are based on a five-year material (2017-2021), retrospectively collected from patients’ records at the University Clinic for Toxicology and Urgent Internal Medicine in Skopje, Macedonia. It is a review of our clinical experience, discussion on the results of articles found in the Pub Med database and data citied in various articles related to management of acute corrosive poisonings.

This type of poisonings happens after an accidental or aware contact with corrosive substances, usually in suicide attempts. Mainly they happen after ingestion of corrosive chemicals, but often we witness injuries of respiratory organs as a result of inhalation of corrosive fumes, or dermal burns, after direct contact with the skin. There are various types of corrosive chemicals, but the majority of cases report contact with acids.

In the diagnosis of this type of intoxications, we use upper endoscopy as a gold standard for quick and proper diagnosis. Nowadays, early computerized tomography is also a recommended procedure for an early evaluation and intervention.

Treatment is based on the clinical condition of patients and it mainly consists of intravenous fluids, antacids, antibiotics, sedatives and protocols for artificial nutrition

References

Christesen HB. Ingestion of caustic agents. Epidemiology, pathogenesis, course, complications and prognosis. Ugeskr laeger 1993; 155(31): 2379-2382. PMID: 8346587.

Park KS. Evaluation and management of caustic injuries from ingestion of Acid or alkaline substances. Clin Endosc 2014; 47: 301-307. doi: 10.5946/ce.2014.47.4.301.

Akkose S, Bulut M, Armagan E, Cebicci H, Fedakar R. Acute poisoning in adults in the years 1996-2001 treated in the Uludag University Hospital, Marmara Region, Turkey. Clin Toxicol (Phila) 2005; 43(2): 105-109. PMID: 15822762.

Chibishev A, Simonovska N, Shikole A. Post-corrosive injuries of upper gastrointestinal tract. Prilozi 2010; 31(1): 297-316. PMID: 20693948

Valdez AL, Casavant MJ, Spiller HA, Chounthirath T, Xiang H, Smith GA. Pediatric exposure to laundry detergent pods. Pediatrics 2014; 134: 1127-1135. doi: 10.1542/ peds.2014-0057.

Hollenbach M, Tünnemann J, Struck MF, Feisthammel J, Schlosser T, Schaumburg T, et al. Endoscopic findings and outcome in caustic ingestion of acidic and alkaline agents in adults: A retrospective analysis. Medicine (Baltimore) 2019; 98(35): e16729.

Bruzzi M, Chirica M, Resche-Rigon M, Corte H, Voron T, Sarfati E, et al. Emergency Computed Tomography Predicts Caustic Esophageal Stricture Formation. Ann Surg 2019; 270(1): 109-114. doi: 10.1097/SLA.0000000000002732.

Day RC, Bradberry SM, Sandilands EA, Thomas SHL, Thompson JP, Vale JA. Toxicity resulting from exposure to oven cleaners as reported to the UK National Poisons Information Service (NPIS) from 2009 to 2015. Clin Toxicol (Phila) 2017; 55: 645-651. doi: 10.1080/15563650.2017.1306070.

Gharbaoui M, Ben Khelil M, Harzallah H, Benzarti A, Zhioua M, Hamdoun M. Pattern of suicide by self-poisoning in Northern Tunisia: an eleven-year study (2005-2015). J Forensic Leg Med 2019; 61: 1-4. doi: 10.1016/j.jflm.2018.10.004.

Najafi F, Hasanzadeh J, Moradinazar M, Faramarzi H, Nematollahi A. An epidemiological survey of the suicide incidence trends in the southwest Iran: 2004-2009. Int J Health Policy Manag 2013; 1: 219-222. doi: 10.15171/ijhpm.2013.40

Cheng HT, Cheng CL, Lin CH, Tang JH, Chu YY, Liu NJ, et al. Caustic ingestion in adults: the role of endoscopic classification in predicting outcome. BMC Gastroenterol 2008; 8:31. doi: 10.1186/1471-230X-8-31.

Centers for Disease Control and Prevention (CDC). Health hazards associated with laundry detergent pods - United States, May-June 2012. MMWR Morb Mortal Wkly Rep 2012 Oct 19;61(41): 825-829. PMID: 23076090.

Davis MG, Casavant MJ, Spiller HA, Chounthirath T, Smith GA. Pediatric exposures to laundry and dishwasher detergents in the United States: 2013-2014. Pediatrics 2016; 137(5): e20154529. doi: 10.1542/peds.2015-4529.

Kardon E. Caustic ingestions from emergency medicine/toxicology. Kreplick LW, Van Der Vootr JT, Dabatt D, Burns MJ, Halamka J, Roberge RJ. 2010. Available from: emedicine.medscape.

Chibishev A, Pereska Z, Chibisheva V, Simonovska N. Corrosive poisonings in adults. Mater Sociomed. 2012; 24(2): 125-130. doi: 10.5455/msm.2012.24.125-130.

Scharman EJ. Liquid “laundry pods”: a missed global toxicosurveillance opportunity. Clin Toxicol (Phila) 2012; 50:725-726.

Satar S, Topal M, Kozaci N. Ingestion of caustic substances by adults: Am J Therap 2004; 11(4): 258-261. doi: 10.1097/01.mjt.0000104487.93653.a2.

Caravati EM. Acids, and alkali (Chapters 201 and 202). In: Dart RC, editor. Medical toxicology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins 2014; 1294-1303, 1304-1309.

Chibishev A, Pareska Z, Chibisheva V, Simonovska N. Clinical and epidemiological features of acute corrosive poisonings. Med Arch 2012; 66(3 Suppl 1): 11-15. doi: 10.545 5/medarh.2012.66.s11-s15.

Kalayarasan R, Ananthakrishnan N, Kate V. Corrosive Ingestion. Indian J Crit Care Med 2019; 23(Suppl 4): S282-S286. doi: 10.5005/jp-journals-10071-23305.

Bonavina L, Chirica M, Skrobic O, Kluger Y, Andreollo NA, Contini S, et al. Foregut caustic injuries: results of the World Society of Emergency Surgery consensus conference. World J Emerg Surg 2015; 10(1): 44. doi: 10.1186/s13017-015-0039-0.

Kikendall JW. Caustic ingestion injuries. Gastroenterol Clin North Am 1991; 20(4):847-857. PMID: 1787017.

Cowan T, Foster R, Isbister GK. Acute esophageal injury and strictures following corrosive ingestions in a 27 year cohort. Am J Emerg Med 2017; 35: 488-492. doi: 10.1016/j.ajem.2016.12.002.

Bonnici KS, Wood DM, Dargan PI. Should computerized tomography replace endoscopy in the evaluation of symptomatic ingestion of corrosive substances? Clin Toxicol 2014; 52(9):911-925. doi: 10.3109/15563650.2014.957310.

Ciammaichella MM, Galanti C, Rossi C. 2019. Caustic ingestion. [Accessed 03/21/2019]. http://www.emjournal.net/htdocs/pages/art/47-caul.html.

Boskovic A, Stankovic I. Predictability of gastroesophageal caustic injury from clinical findings: is endoscopy mandatory in children? EurJ Gastroenterol Hepatol 2014; 26(5): 499-503. doi: 10.1097/MEG.0000000000000060.

Pennachi C, de Moura DTH, Amorim RBP, Guedes HG, Kumbhari V, deMoura EGH. Lugol’s iodine chemoendoscopy versus narrowband image enhanced endoscopy for the detection of esophageal cancer in patients with stenosis secondary to caustic/corrosive agent ingestion. Arg Gastroenterol 2017; 54(3): 250-254. doi: 10.1590/S0004-2803.20170 0000-19.

Chibishev A, Pereska Z, Simonovska N, Chibisheva V, Glasnovic M, Chitkushev LT. Conservative therapeutic approach to corrosive poisonings in adults. J Gastrointest Surg 2013; 17(6): 1044-1049. doi: 10.1007/s11605-013-2190-9. Se povtoruva so 54

de Lusong MAA, Timbol ABG, Tuazon DJS. Management of esopheagelcaustic injury. WJGPT 2017; 8(2): 90-98. doi: 10.4292/wjgpt.v8.i2.90.

Le Naoures P, Hamy A, Lerolle N, Métivier E, Lermite E, Venara A. Risk factors for symptomatic esophageal stricture after caustic ingestion-a retrospective cohort study. Dis Esophagus 2017; 30(6): 1-6. doi: 10.1093/dote/dox029.

Struck MF, Beilicke A, Hoffmeister A, Gockel I, Gries A, Wrigge H, et al. Acute emergency care and airway management of caustic ingestion in adults: single center observational study. Scand J Trauma Resusc Emerg Med 2016; 24: 45. doi: 10.1186/ s13049-016-0240-5.

Alipour Faz A, Arsan F, Peyvandi H, Oroei M, Shafagh O, Peyvandi M, et al. Epidemiologic Features and Outcomes of Caustic Ingestions; a 10-Year Cross-Sectional Study. Emerg (Tehran) 2017; 5(1): e56. PMID: 28894772; PMCID: PMC5585826.

Nagi B, Kochhar R, Thapa BR, Singh K. Radiological spectrum of late sequelae of corrosive injury to upper gastrointestinal tract. A pictorial review. Acta Radiol 2004; 45(1): 7-12. doi: 10.1080/02841850410003329.

Kochhar R, Ashat M, Reddy YR, Dhaka N, Manrai M, Sinha SK, et al. Relook endoscopy predicts the development of esophageal and antropyloric stenosis better than immediate endoscopy in patients with caustic ingestion. Endoscopy 2017; 49(7): 643-650. doi: 10.1055/s-0043-104857.

Chirica M, Bonavina L, Kelly MD, Sarfati E, Cattan P. Caustic ingestion. Lancet 2017; 389(10083): 2041-2052. doi: 10.1016/S0140-6736(16)30313-0.

Bruzzi M, Chirica M, Resche-Rigon M, Corte H, Voron T, Sarfati E, et al. Emergency Computed Tomography Predicts Caustic Esophageal Stricture Formation. Ann Surg 2019; 270(1): 109-114. doi: 10.1097/SLA.0000000000002732.

Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult Airway Society intubation guidelines working group. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 2015; 115(6): 827-848. doi: 10.1093/bja/aev371.

Bird JH, Kumar S, Paul C, Ramsden JD. Controversies in the management of caustic ingestion injury: an evidence-based review. ClinOtolaryngol 2017; 42(3): 701-708. doi: 10.1111/coa.12819.

Tosca J, Villagrasa R, Sanahuja A, Sanchez A, Trejo GA, Herreros B, et al. Caustic ingestion: development and validation of a prognostic score. Endoscopy 2021; 53(8): 784-791. doi: 10.1055/a-1297-0333.

Kluger Y, Ishay OB, Sartelli M, Katz A, Ansaloni L, Gomez CA, et al. Caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion. World J Emerg Surg 2015; 10: 48. doi: 10.1186/s13017-015-0043-4.

Usta M, Erkan T, Cokugras FC, Urganci N, Onal Z, Gulcan M, et al. High doses of methylprednisolone in the management of caustic esophageal burns. Pediatrics 2014; 133: E1518-E1524. doi: 10.1542/peds.2013-3331.

Peclova D. Navratil, Do corticosteroids prevent oesophageal stricture aftercorrosive ingestion. Toxicol Rev 2005; 24: 125-129. doi: 10.2165/00139709-200524020-00006.

Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol 2013; 19: 3918-3930. doi: 10.3748/wjg.v19.i25.3918.

Rathnaswami A, Ashwin R. Corrosive Injury of the upper gastrointestinal tract: a review. Arch Clin Gastroenterol 2016; 2: 56-62.

Cakal B, Akbal E, Köklü S, Babalı A, Koçak E, Taş A. Acute therapy with intravenous omeprazole on caustic esophageal injury: a prospective case series. Dis Esophagus 2013; 26: 22-26. doi: 10.1111/j.1442-2050.2011.01319.x.

Coronel G, De Lusong M. Sucralfate for the prevention of esophageal stricture formation in corrosive esophagitis: an open label, randomized controlled trial. Endoscopy 2011; 43(Suppl 1): A42.

El-Asmar KM, Hassan MA, Abdelkader HM, Hamza AF. Topical mitomycin C can effectively alleviate dysphagia in children with long-segment caustic esophageal strictures. Dis Esophagus 2015; 28: 422-427. doi: 10.1111/dote.12218.

Méndez-Nieto CM, Zarate-Mondragón F, Ramírez-Mayans J, Flores-Flores M. Topical mitomycin C versus intralesional triamcinolone in the management of esophageal stricture due to caustic ingestion. Rev Gastroenterol Mex 2015; 80: 248-254. doi: 10.1016/j.rgmx.2015.07.006.

Wang RW, Zhou JH, Jiang YG, Fan SZ, Gong TQ, Zhao YP, et al. Prevention of stricture with intraluminal stenting through laparotomy after corrosive esophageal burns. Eur J Cardiothorac Surg 2006; 30(2): 207-211. doi: 10.1016/j.ejcts.2006.03.068.

Repici A, Vleggaar FP, Hassan C, van Boeckel PG, Romeo F, Pagano N, et al. Efficacy and safety of biodegradable stents for refractory benign esophageal strictures: the BEST (Biodegradable Esophageal Stent) study. Gastrointest Endosc 2010; 72(5): 927-934. doi: 10.1016/j.gie.2010.07.031.

Nijhawan S, Udawat HP, Nagar P. Aggressive bougie dilatation and intralesional steroids is effective in refractory benign esophageal strictures secondary to corrosive ingestion. Dis Esophagus 2016; 29: 1027-1031. doi: 10.1111/dote.12438.

Chibishev A, Markoski V, Smokovski I, Shikole E, Stevcevska A. Nutritional therapy in the treatment of acute corrosive intoxication in adults. Mater Sociomed 2016;28(1): 66-70. doi: 10.5455/msm.2016.28.66-70.

Chirica M, Kelly MD, Siboni S, Aiolfi A, Riva CG, Asti E, et al. Esophageal emergencies: WSES guidelines. World J Emerg Surg 2019; 14:26. doi: 10.1186/s13017-019-0245-2.

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Published

2023-03-31

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Review Article