Accordingly, alkali ingestion may lead to more serious injury and complications, but this distinction is probably not clinically relevant in the setting of strong acid or base ingestion, both being able to penetrate tissues rapidly, potentially leading to full-thickness damage of the esophageal/gastric wall. A recent animal study from Brazil12 showed that a low concentration solution (1.83%) was able to produce esophageal epithelial necrosis in 1 hour. Chirica M, Veyrie N, Munoz-Bongrand N, Zohar S, Halimi B, Celerier M, Cattan P, Sarfati E. Late morbidity after colon interposition for corrosive esophageal injury: risk factors, management, and outcome. Minimal resection followed by a planned second-look procedure is not recommended. Mukherjee K, Cash MP, Burkey BB, Yarbrough WG, Netterville JL, Melvin WV. It is made of solid white crystals that absorb water from the air. Address correspondence to: Ronald Amedee, MD, Department of Otolaryngology-Head & Neck Surgery, Ochsner Clinic Foundation, 1514 Jefferson highway, New Orleans, LA 70121, (504)-842-4080, (504)-842-3979, e-mail: Caustic ingestion, caustic substance, corrosive injury, corrosive substance, endoscopy, esophageal stricture. Mittal BR, Kochhar R, Shankar R, Bhattacharya A, Solanki K, Nagi B. Kochhar R, Sriram PV, Ray JD, Kumar S, Nagi B, Singh K. Intralesional steroid injections for corrosive induced pyloric stenosis. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. The roles of these major de-inking chemicals are briefly discussed below. FOIA Ingestion of corrosive substances remain an important public health issue in Western countries despite education and regulatory efforts to reduce its occurrence. With the advantage of not being invasive, CT scan has a promising role in the early evaluation of caustic injury damage. Moreover, gastrostomy allows a retrograde approach for dilatation, which is usually easier and safer[111,112]. Sodium hydroxide, a highly alkaline substance, is also called caustic soda. 0000011054 00000 n Bueno R, Swanson SJ, Jaklitsch MT, Lukanich JM, Mentzer SJ, Sugarbaker DJ. Comparison of titratable acid/alkaline reserve and pH in potentially caustic household products. Steroids: Systemic administration of steroids seems ineffective in preventing strictures[55,56], especially in patients with 3rd degree esophageal burns. based on any of the following: PDF documents can be viewed with the free Adobe Reader, Signs/symptoms from exposure to the substance, Substance categories (flammable, meth lab, etc. Although the indications and descriptions of standard of care are useful, the unpredictable nature of these injuries continues to trump expectations for patient outcomes and for complications. (2002). In any case they should not be placed blindly because of the risk of esophageal perforation[53]. Although severe esophageal injuries have been reported in 12.0%[47] and 19.3%[48] of asymptomatic children, significant lesions at endoscopy are not usually observed when symptoms are absent after unintentional ingestion of less aggressive substances[24,49], thus making routine post-ingestion endoscopy questionable in this group of patients. Stridor, vomiting, painful swallowing, drooling, and abdominal pain are early symptoms of sodium hydroxide ingestion. Tseng YL, Wu MH, Lin MY, Lai WW. Esophagogastroduodenoscopy is considered crucial and usually recommended in the first 12-48 h after caustic ingestion, though it is safe and reliable up to 96 h after the injury[13,42]; gentle insufflation and great caution are mandatory during the procedure. 0000001490 00000 n Anderson K. D., Rouse T. M., Randolph J. G. A controlled trial of corticosteroids in children with corrosive injury of the esophagus. Bethesda, MD 20894, Web Policies Esophageal stricture may be seen as early as 3 weeks after ingestion.2,15 It occurs in 10% to 20% of caustic injuries, most commonly at the level of the cricoid cartilage, the region of the aortic arch, and below the left main stem bronchus, as well as the esophageal hiatus, all of which are anatomic regions of narrowing in the esophagus.1,11 Stricture can lead to severe dysphagia, with approximately 80% of strictures causing obstructive symptoms 2 months after their formation.8 Of children ingesting alkalis, 30% will develop esophageal burns; of these, 50% will develop strictures.5 Severe and recalcitrant strictures may require esophageal replacement with colon or jejunum interpositional grafts, while less severe strictures are managed with dilation.1,2,5,11,15 Balloon dilation is the procedure of choice for management of most strictures in children.4 The literature suggests a baseline barium esophagram 3 to 4 weeks after ingestion to establish baseline for future stricture formation.1 Complications of stricture include nutritional compromise, hospitalization, chronic anemia, and repeated dilations.1. There is a consensus that patients treated with steroids should also be treated with antibiotics, but prophylactic antibiotics to prevent strictures, in the absence of steroid therapy, has not been advocated[72]. Alkaline disk batteries contain a 45% solution of potassium hydroxide or sodium hydroxide. 0000002687 00000 n Berger M, Ure B, Lacher M. Mitomycin C in the therapy of recurrent esophageal strictures: hype or hope? 0000002648 00000 n Delayed gastric emptying with consequent accumulation of food in the stomach (likely due to the contraction of the antropyloric region) may affect the severity of injuries. Milk and activated charcoal are contraindicated because may obscure subsequent endoscopy. Any esophageal catheterization may be a nidus for infection and nasogastric placement may worsen gastroesophageal reflux in this patient population, with a consequent delay in mucosal healing. Zerbib P, Voisin B, Truant S, Saulnier F, Vinet A, Chambon JP, Onimus T, Pruvot FR. When airway compromise is present, a definitive airway must be established. The dissolution/dissociation in water is strongly exothermic, so a vigorous reaction occurs when sodium hydroxide is added to water. December 31, 2007. The .gov means its official. ea`(r,WS3!4BA `e` X ,"Xx)MEXA#F'&9 J lXD u,W"f~ p20i& 0 $ endstream endobj 51 0 obj 178 endobj 16 0 obj << /Type /Page /Parent 13 0 R /Resources 17 0 R /Contents [ 23 0 R 25 0 R 27 0 R 29 0 R 31 0 R 35 0 R 39 0 R 41 0 R ] /MediaBox [ 0 0 612 792 ] /CropBox [ 0 0 612 792 ] /Rotate 0 >> endobj 17 0 obj << /ProcSet [ /PDF /Text ] /Font << /TT1 19 0 R /TT2 33 0 R /TT3 37 0 R >> /ExtGState << /GS1 46 0 R >> /ColorSpace << /Cs6 20 0 R /Cs8 21 0 R >> >> endobj 18 0 obj << /Type /FontDescriptor /Ascent 891 /CapHeight 0 /Descent -216 /Flags 34 /FontBBox [ -558 -307 2034 1026 ] /FontName /FCBBFA+TimesNewRoman,Bold /ItalicAngle 0 /StemV 133 /FontFile2 42 0 R >> endobj 19 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 146 /Widths [ 250 0 0 500 0 0 0 0 333 333 0 0 250 333 250 278 500 500 500 500 500 500 0 500 500 500 333 0 0 0 0 500 0 722 0 722 722 667 611 778 778 389 0 0 667 944 722 778 611 778 722 556 667 722 722 1000 722 722 0 0 0 0 0 0 0 500 556 444 556 444 333 500 556 278 0 556 278 833 556 500 556 556 444 389 333 556 500 722 500 500 444 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 333 ] /Encoding /WinAnsiEncoding /BaseFont /FCBBFA+TimesNewRoman,Bold /FontDescriptor 18 0 R >> endobj 20 0 obj [ /ICCBased 47 0 R ] endobj 21 0 obj [ /Separation /All 20 0 R 45 0 R ] endobj 22 0 obj 1496 endobj 23 0 obj << /Filter /FlateDecode /Length 22 0 R >> stream Gastric outlet obstruction has an incidence of 5%[67], mainly in the prepyloric area, where prolonged contact with the antral mucosa due to pyloric spasms and to resulting pooling of the caustic agent in this region[55] usually results in stricture in more than 60% of patients[68]. Esophageal injury begins within minutes and may persist for hours. Zargar SA, Kochhar R, Mehta S, Mehta SK. Please remove adblock to help us create the best medical content found on the Internet. about navigating our updated article layout. Repici A, Vleggaar FP, Hassan C, van Boeckel PG, Romeo F, Pagano N, Malesci A, Siersema PD. Katzka DA. Surgery for non-responding esophageal strictures: When esophageal dilatation is not possible or fails to provide an adequate esophageal caliber in the long-term, esophageal replacement by retrosternal stomach or, preferably, right colonic interposition should be considered. 14 0 obj << /Linearized 1 /O 16 /H [ 1200 290 ] /L 90227 /E 81466 /N 2 /T 89829 >> endobj xref 14 38 0000000016 00000 n This includes prompt . Spectrum of injury to upper gastrointestinal tract and natural history. In such a scenario, feeding by nasogastric tube for long periods may be tolerated with difficulty and a gastrostomy is more effective and often necessary to attain an acceptable nutritional state. Steroids are usually reserved for patients with symptoms involving the airway[55,56]. Aspiration of either acid or alkali can also induce both laryngeal and tracheobronchial injury. Responses of the murine esophageal microcirculation to acute exposure to alkali, acid, or hypochlorite. official website and that any information you provide is encrypted 0000075803 00000 n Ingestion Ingestion of hypochlorite solutions causes vomiting and corrosive injury to the gastrointestinal tract. Sodium Hydroxide | NaOH or HNaO | CID 14798 - structure, chemical names, physical and chemical properties, classification, patents, literature, biological activities, safety/hazards/toxicity information, supplier lists, and more. Maximal esophageal wall thickness, observed at CT scan, was associated with a higher number of sessions required for adequate dilatation[92], and recurrent strictures were significantly more frequent after delayed dilatation (Figure (Figure44)[93-95]. Therefore, after caustic injuries the placement of a nasogastric tube may be considered, but the decision should be made with caution and done on a case-by-case basis. Sodium hydroxide is a pH balancer used in a wide range of beauty and skin care items, like cleansers, soaps, makeup, and creams or lotions. Most of the ingestions seen in this population are intentional suicide attempts.1,4,5. Ingestion of corrosive substances is increasingly reported in developing countries, due to lack of education and prevention. The system shown in Table 2 correlates findings seen on endoscopy. Early surgical correction for isolated gastric stricture following acid corrosion injury. Author contributions: Both authors substantially contributed to the article and approved the final version to be published. Adverts are the main source of Revenue for DoveMed. Ramasamy K, Gumaste VV. Recently, some concerns have been raised about the correlation between endoscopic findings and the extent of necrosis[39]: gastrectomy was considered unnecessary at laparotomy in 12% of patients with gastric injuries staged 3b at endoscopy, while the decision to perform esophagectomy based exclusively on endoscopic findings led to unnecessary esophagectomy in 15% of cases[52], suggesting the need for better criteria to improve patient selection for emergency surgery.
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