Surgical management of gastric cicatrisation resulting from corrosive ingestion. Steroids have been a controversial treatment since they were first shown to decrease granulation and stricture formation in animal models. 0000013004 00000 n Gaudreault P, Parent M, McGuigan MA, Chicoine L, Lovejoy FH. Is endoscopy always necessary? Gastric lavage and induced emesis are contraindicated for the risk of re-exposure to the corrosive agent and additional injury to the esophagus. 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. The innermost is the mucosa, consisting of squamous epithelium, lamina propria, and muscularis mucosa. Symptoms of Caustic Substances Poisoning. Ferry G. D. Caustic esophageal injury in children. 0000076898 00000 n official website and that any information you provide is encrypted Do not induce . Laboratory and endoscopic criteria for emergency surgery have been suggested, including disseminated intravascular coagulation, renal failure, acidosis and third degree esophageal burns[58,61]. Concentrated vapors lead to serious damage to the eyes and respiratory system. It is also known as lye Sodium hydroxide has a variety of domestic, commercial, and industrial uses. With the advantage of not being invasive, CT scan has a promising role in the early evaluation of caustic injury damage. It is also known as lye and caustic soda. Temiz A, Oguzkurt P, Ezer SS, Ince E, Gezer HO, Hicsonmez A. Sodium hydroxide, This is for information only and not for use in the treatment or management of an actual poison exposure. CAUSTIC SODA, CAUSTIC SODA; SODIUM HYDROXIDE; SODIUM HYDROXIDE, SODIUM HYDRATE, SODIUM HYDROXIDE, SODIUM HYDROXIDE (NA(OH)), and . When lip and oropharyngeal injuries are the main clinical findings, esophageal or gastric injuries are generally no greater than grade 1[46]. Finally, a recent case will be presented that highlights the difficulty this problem poses to a medical team. If it is felt necessary to confirm a clinically suspected perforation, a water-soluble agent, such as Hypaque or Gastrografin, and less irritant than barium sulphate, should probably be used, though both can be equally irritant[35]. Sodium hydroxide is toxic by oral ingestion 2. Corrosive carcinoma of the esophagus. Mortality and morbidity for caustic ingestion is most severe for extensive injuries. The patient never tolerated oral intake. There is no role for procedures such as closure of a perforation. In: Bluestone C. D., Stool S. E., Kenna M. A., editors. The https:// ensures that you are connecting to the Stridor, vomiting, painful swallowing, drooling, and abdominal pain are early symptoms of sodium hydroxide ingestion. In spite of these encouraging reports, the role of US examination in caustic injuries is still under evaluation. At room temperature, sodium hydroxide is a white crystalline odorless solid that absorbs moisture from the air. Cakal B, Akbal E, Kkl S, Babal A, Koak E, Ta A. This helps dissolve most of the unwanted material in the wood, leaving relatively pure cellulose, which forms the basis of paper. Introduction: Sodium hypochlorite is used as a bleaching and disinfecting agent and is commonly found in household bleach. The Mattos G. M., Lopes D. D., Mamede R. C., Ricz H., Mello-Filho F. V., Neto J. Perforation of the esophagus can lead to tracheoesophageal fistula, mediastinitis, pneumonia, and sepsis, requiring immediate esophagectomy with resultant cervical esophagostomy and gastrostomy.1,4,9,11 Perforation of the stomach or duodenum may lead to peritonitis, shock, and death.4 Such injuries require surgical interventions such as exploratory laparotomy.4,5 Burns to the larynx result in airway loss and strictures; treatment includes tracheostomy and further reconstructive surgeries.16 Some authors1 suggest early reconstruction for grade 3 and some grade 2 injuries to prevent stricture and perforation complications. 0000001200 00000 n Demirbilek S, Aydin G, Ycesan S, Vural H, Bitiren M. Polyunsaturated phosphatidylcholine lowers collagen deposition in a rat model of corrosive esophageal burn. . Rarely, a full thickness burn can cause an immediate gastric perforation, which tends to present a few days after ingestion. Coloplasty dysfunction is responsible for half of the failures, with an overall 70% success rate after revision surgery in expert hands. This number may be higher in adults who often consume larger amounts of the caustic substance as part of a suicide attempt.7,8 Because of its importance, a large portion of the discussion will be concerned with esophageal injuries. Moreover, delayed presentation and treatment have been found to be strong predictors of future esophageal replacement[96]. 0000009673 00000 n Sandgren K, Malmfors G. Balloon dilatation of oesophageal strictures in children. As can be seen, the patient's upper airway was grossly edematous with white exudates (grade 2) and we recommended the patient remain intubated. Moreover, in industrialized and developing countries, the therapeutic approach and management strategies appear to be different, likely because of technology and endoscopic expertise. Carver GM, Sealy WC, Dillon ML. If contamination with white phosphorus has occurred, thoroughly irrigate the area with. Initially, tissue injury is marked by eosinophilic necrosis with swelling and hemorrhagic congestion[9]. Endoscopic classification[8] is important for prognosis and management (Table (Table3).3). Acute surgery is quite exceptional in the pediatric population and most authors recommend exhausting all resources to try to preserve the childs native esophagus[25]. This low rate of lower airway and pulmonary complications suggests that the protective pharyngeal-glottic mechanism is highly efficient in preventing the caustic substance to reach the lower airway. The roles of these major de-inking chemicals are briefly discussed below. Perforation may occur during this period if ulceration exceeds the muscle plane. Erdoan E, Erolu E, Tekant G, Yeker Y, Emir H, Sarimurat N, Yeker D. Management of esophagogastric corrosive injuries in children. In more severe cases (grade 2 or 3), observation in an intensive care unit and adequate nutritional support is required. Though resection of the scarred esophagus may be performed without a substantial increase in morbidity and mortality compared to by-pass[120], a 13% incidence of esophageal cancer after by-pass[93], the risk of infected esophageal mucocele in 50% of the patients after 5 years[94], and the impossibility of endoscopic follow-up for cancer are all arguments favoring esophageal resection. 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]. Steroids in second degree caustic burns of the esophagus: a systematic pooled analysis of fifty years of human data: 1956-2006. However, endoscopic gastric dilatation should be considered a temporary substitute for surgical resection because gastric wall fibrosis usually diminishes the long-term functional result[129,130]. However, timely and early surgery may be the only hope for patients with severe injuries, and a rather aggressive attitude should be considered in such patients. Gastrostomy may be lifesaving in this perspective. Odonnell CH, Abbott WE, Hirshfeld JW. Effects of time of contact and concentration of caustic agent on generation of injuries. Early surgical correction for isolated gastric stricture following acid corrosion injury. In liquid form, bases are tasteless and denser than water, resulting in pronounced distal injuries1,9 Alkali ingestion causes liquefactive necrosis with diffusion into deeper layers of the injured mucosa. Treatment consists of respiratory and cardiovascular support. Surgical management of extensive corrosive injuries of the alimentary tract. Damage to the mouth, throat and stomach is immediate. Bleeding following corrosive ingestion is usually self-limiting: though massive hemorrhage from the stomach or duodenum has been reported a short time after corrosive ingestion[30], severe bleeding typically occurs at 2 wk after ingestion[29]. Reproduced from Kamijo et al[37]. When dissolved in water or neutralized with acid it liberates substantial heat, which may be sufficient to ignite combustible materials. Despite this, they rarely cause severe injury or sequelae; thus, treatment is largely conservative with overnight observation and management.4, Acids, in contrast to alkali substances, have a poor taste and are irritating, which may lead to a child's choking and gagging. Kamijo Y, Kondo I, Kokuto M, Kataoka Y, Soma K. Miniprobe ultrasonography for determining prognosis in corrosive esophagitis. 1) Dilute with 4 to 8 ounces of water may be useful if it can be performed shortly after ingestion in patients who are able to swallow, with no vomiting or respiratory distress; then the patient should be NPO until assessed for the need for endoscopy. Other sequelae may occur that require surgical management. Nez O, Gonzlez-Asanza C, de la Cruz G, Clemente G, Baares R, Cos E, Menchn P. Study of predictive factors of severe digestive lesions due to caustics ingestion. First-aid measures after ingestion : Rinse mouth with water. This article discusses poisoning from touching, breathing in (inhaling), or swallowing sodium hydroxide. Ingestion of corrosive substances by adults. Esophageal repair usually begins on the 10 th day after ingestion, whereas esophageal ulcerations begin to epithelialize approximately 1 mo after exposure. His injuries were deemed grade 2a. Ultimately, though endoscopy is considered by most a cornerstone in the diagnosis of corrosive ingestions, which patients would clearly benefit from it is still debated. Hawkins DB. *Department of Otolaryngology, Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA, Department of Otolaryngology, Head and Neck Surgery, Ochsner Clinic Foundation, New Orleans, LA. 0000006712 00000 n 0000075803 00000 n This issue, which may entail different management strategies[3] for early or late patients, may be crucial in developing countries, where late presentations are more than 50%[2,97,98]. Reproduced from Osman et al[10]. Fulton JA, Hoffman RS. Total gastrectomy may be necessary. GER is indeed a likely significant factor in persistent strictures not responding to sequential esophageal dilatations. Blind intubation can lead to bleeding and additional injury and make additional attempts more difficult. Neutralization, activated charcoal, and gastric lavage are all contraindicated. Data available are heavily skewed towards well-resourced centers and do not mirror the full reality of the condition. 0000004336 00000 n The more demanding pharyngoesophageal strictures may be treated with acceptable results, provided considerable expertise is available[121]. NaOH is available in concentrations of up to 50%, which is the most commonly used concentration. Delayed gastric emptying in patients with caustic ingestion. Ananthakrishnan N, Parthasarathy G, Kate V. Acute corrosive injuries of the stomach: a single unit experience of thirty years. Common signs to watch for: Drooling Pawing at the mouth Patients with clinical or radiological evidence of perforation require immediate laparotomy, usually followed by esophagectomy, cervical esophagostomy, frequently concomitant gastrectomy and even more extensive resections, and jejunostomy feeding[58-60]. PMC legacy view This article discusses poisoning from touching, breathing in (inhaling), or swallowing sodium hydroxide. In contrast, a meta-analysis of 362 children showed a 40% rate of stricture in the no-steroid group versus a 19% rate of stricture in the steroid-treated group.14, The landmark randomized trial by Anderson et al2 found no difference in the incidence of stricture formation with the use of steroids, though the number of patients in the study was relatively low. This includes prompt . Antibiotics: Though an old study reports a marked decrease in stricture formation with the use of antibiotics[71], no prospective trial evaluated their utility, and their value in the setting of caustic ingestion, in the absence of concomitant infection, is unknown[18]. Friedman E. M. Caustic ingestion and foreign bodies in the aerodigestive tract. Podlovchenko, B. I., Manzhos, R. A., & Maksimov, Y. M. (2002). Technetium-labeled sucralfate swallow has high sensitivity and specificity but limited ability to show extent of injury. Before 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. Rigid endoscopy is recommended for nasogastric tube placement and airway management.1, The timing of endoscopy and the circumstances for its use, as recommended in the literature, are controversial. Cheng YJ, Kao EL. 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]. 0000014395 00000 n The site is secure. Sodium hydroxide is very corrosive. However, secondary extension of caustic burns is unpredictable and re-exploration is indicated when in doubt. Tiryaki T, Livaneliolu Z, Atayurt H. Early bougienage for relief of stricture formation following caustic esophageal burns. The patient's past medical and surgical history were unremarkable. Moreover, gastrostomy allows a retrograde approach for dilatation, which is usually easier and safer[111,112]. Bothereau H, Munoz-Bongrand N, Lambert B, Montemagno S, Cattan P, Sarfati E. Esophageal reconstruction after caustic injury: is there still a place for right coloplasty? In challenging patients, a surgical airway may be required. Sarfati E, Gossot D, Assens P, Celerier M. Management of caustic ingestion in adults. Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. 2 NH Locations: Landcare Stone Madbury, NH Stratham Hill Stone Stratham, NH Shipping Nationwide Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Caustic injury: can CT grading system enable prediction of esophageal stricture? Essentially, laboratory studies are more useful in monitoring and guiding patient management than in predicting morbidity or mortality[34]. Katzka DA. Endoscopy past 48 hours is discouraged because of progressive wall weakening and increased risk of perforation.1 Most agree that strong alkali ingestion mandates endoscopy, while asymptomatic or questionable ingestions may be observed, according to some sources.1,4, Treatment schemes for caustic injuries vary and no consensus exists. Please remove adblock to help us create the best medical content found on the Internet. What is sodium hydroxide food grade? The patient received a nasogastric tube over a guide wire and was given multiple broad spectrum antibiotics without steroids. Caustics and Batteries. Gerek A, Ay B, Dogan V, Kiyan G, Dagli T, Gogus Y. Esophageal balloon dilation in children: prospective analysis of hemodynamic changes and complications during general anesthesia. Spectrum of injury to upper gastrointestinal tract and natural history. Clinical features depend on the type of the substance, amount, physical form and time of presentation (early or delayed). Dilatation should be avoided from 7 to 21 d after ingestion for the risk of perforation, though early, prophylactic dilatation with bougienage has been reported to be safe and effective even in this period[43]. Gnel E, Calayan F, Calayan O, Akilliolu I. Reactive oxygen radical levels in caustic esophageal burns. Obtain . Early surgery has been advised to decrease mortality and morbidity[67,126]. December 31, 2007. Late sequelae of gastric acid injury. Reproduced from Ryu et al[40]. SRP: The most favorable course of action is to use an alternative chemical product with less inherent propensity for occupational harm/injury/toxicity or environmental contamination. [PDF]f Sodium can cause headache,, also known as lye and caustic soda, Sodium chloride would be the produce of sodium hydroxide and hydrochloric acid. Dilatation can be carried out with balloon or bougies (usually Savary) without a clear advantage for each method[70]. A high white blood cell count (> 20000 cells/mm3), elevated serum C-reactive protein, age and the presence of an esophageal ulcer have been considered predictors of mortality in adults[32]; an arterial pH less than 7.22 or a base excess lower than -12 have been considered indication of severe esophageal injury and of emergency surgery[33]. Cytokines have also been used experimentally with success to prevent stricture formation[90]. 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. Moreover, positioning a nasogastric tube has the advantage of providing a lumen for dilatation should a tight stricture develops. Keh SM, Onyekwelu N, McManus K, McGuigan J. Corrosive injury to upper gastrointestinal tract: Still a major surgical dilemma. It is used in soaps and detergents, textiles, dyes, pulp and paper products, explosives, and petroleum products Therefore, the use of the balloon catheter in children entails careful intraoperative monitoring and likely requires greater endoscopic skill and experience than for Savary bougies. The most common presentation of an acute corrosive gastric burn is abdominal pain, vomiting, and hematemesis. Shampoo. Bleaches such as chloride bleach, peroxide, and mildew remover are also considered caustic esophageal irritants, though pH is typically neutral in commercial preparations.1,5,9 Because of the low concentrations and the neutral pH, bleaches do not cause extensive esophageal damage, though they may cause laryngeal edema and airway compromise in the short-term setting.1, As mentioned above, the esophagus is the site of most long-term sequelae from caustic ingestion. Chirica M, Resche-Rigon M, Bongrand NM, Zohar S, Halimi B, Gornet JM, Sarfati E, Cattan P. Surgery for caustic injuries of the upper gastrointestinal tract. The topicFirst Aid forSodium Hydroxide Poisoning you are seeking is a synonym, or alternative name, or is closely related to the topicFirst Aid for Caustic Soda Poisoning. It is a manufactured substance. Turner A, Robinson P. Respiratory and gastrointestinal complications of caustic ingestion in children. The preservation of the native esophagus is still debated. Gnel E, Calayan F, Calayan O, Canbilen A, Tosun M. Effect of antioxidant therapy on collagen synthesis in corrosive esophageal burns. Treatment consists of respiratory and cardiovascular support. 8600 Rockville Pike (2002). School Chemistry Laboratory Safety Guide. Sarioglu-Buke A, Corduk N, Atesci F, Karabul M, Koltuksuz U. Patients may have obvious burns to the lips, mouth, and oropharyx. Sunway In: Bailey B. J., Johnson J. T., Newlands S. D., editors. As evidenced by the above case, complications can occur even in low-grade injuries, though most long-term sequelae are seen in injuries that are more severe. In any case they should not be placed blindly because of the risk of esophageal perforation[53]. It is generally used as a solid or a 50% solution. The esophagus is a 10 to 12 cm tube at birth, which increases to from 25 to 30 cm in the adult. Antegrade and retrograde endoscopy for treatment of esophageal stricture. Sodium hydroxide is a common constituent of many household and industrial cleaners including oven cleaners and beerline cleaners. Symptoms may take anywhere from 2-12 hours to develop. Esophageal injury begins within minutes and may persist for hours. These injuries are still increasing in developing countries[1,2], related to the social, economic, and educational variables and mainly to a lack of prevention[3,4]. Minimal resection followed by a planned second-look procedure is not recommended. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. seconds or you may click one of the buttons below. This is clinically relevant to healing because collagen deposition may not begin until the second week after injury; thus, the healing tissue will be less strong. When late reconstructive surgery is carried out after early emergency surgical treatment, the outcome is strongly influenced by coloplasty dysfunction, responsible for half of the failures. Early and late term management in caustic ingestion in children: a 16-year experience. After extubation the patient had persistent difficulty with secretions. Tettey M, Edwin F, Aniteye E, Tamatey M, Entsua-Mensah K, Ofosu-Appiah E, Frimpong-Boateng K. Colopharyngoplasty for intractable caustic pharyngoesophageal strictures in an indigenous African community--adverse impact of concomitant tracheostomy on outcome. Javed A, Pal S, Dash NR, Sahni P, Chattopadhyay TK. The functional success rate after colon reconstruction at 5 years is 77% and the severity of the initial insult or a delay more than 6 mo, may strongly influence the outcome[119]. The effect that these agents have on the esophagus accounts for most of the serious injuries and long-term complications seen among both children and adults.3 Short-term complications include perforation and death. The reported incidence ranges from 2% to 30%, with an interval from 1 to 3 decades after ingestion[53]. Moreover, assessment of the limits of the gastric resection may be difficult, due to ongoing fibrosis. FELDSTEIN, M. (2013). Moreover, impaired vagal cholinergic transmission, possibly due to the same mechanism[117] can explain the increased fasting gallbladder volume and decreased gallbladder emptying found in patients after lower esophageal damage. Saponification of fats, denaturation of proteins, and blood vessel thrombosis will occur during the injury process.1,4,5,11 This injury occurs quickly, with a 30% solution of sodium hydroxide being able to produce full thickness sharing sensitive information, make sure youre on a federal Russian journal of electrochemistry,38(12), 1292-1298. Foschia F, De Angelis P, Torroni F, Romeo E, Caldaro T, di Abriola GF, Pane A, Fiorenza MS, De Peppo F, DallOglio L. Custom dynamic stent for esophageal strictures in children. Stricture prevention by stents seems promising but the experience is still limited. Zerbib P, Voisin B, Truant S, Saulnier F, Vinet A, Chambon JP, Onimus T, Pruvot FR. Ingestion of sodium hydroxide can cause spontaneous vomiting, chest and abdominal pain, and difficulty swallowing with drooling. 8600 Rockville Pike Nasogastric tubes may be applied to prevent vomiting and as stent in severe circumferential burns, but their validity has never be proven. 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. In this case report, two dogs ingested an unknown volume of Clorox Regular-Bleach (The Clorox Company) containing 6.15% sodium hypochlorite and subsequently developed marked hypernatremia and hyperchloremia as well as numerous other biochemical abnormalities. Combined antegrade and retrograde dilation: a new endoscopic technique in the management of complex esophageal obstruction. Potassium hydroxide is a caustic chemical. Objective: The objective is to review critically the epidemiology, mechanisms of toxicity, clinical features, diagnosis, and management of hypochlorite poisoning. Federal government websites often end in .gov or .mil. Hot Zone : Rescuers should be trained and appropriately attired . Endoscopic dilatation is usually successful in achieving a patent esophageal lumen, but in complex strictures several attempts must be carried out, and in such patients bougies may be preferred to balloon dilatation. Main late sequelae include esophageal strictures, often accompanied by undernourishment, especially in developing countries. Surgery for stomach injuries: The timing and type of elective surgery for gastric outlet obstruction is still controversial. Moreover, cost and minimal experience in caustic strictures make the use of biodegradable devices questionable, especially in developing countries. Sodium hydroxide is a very strong chemical that is also known as lye and caustic soda. An emergency tracheostomy may have an adverse impact on the outcome of a colopharyngoplasty[139]. At surgery, a gastrotomy allows an accurate evaluation of the extent of damage, since mucosal (and transmural) necrosis may be more extensive than what is apparent from the serosal side. 77, No. 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. Endoscopic balloon dilatation and/or intralesional steroid injection have been proposed as alternatives[127,128]. NaOH is a one normal. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Corrosive ingestion in adults. A good nutritional state is crucial for a successful outcome, especially in children, and both an improvement in nutritional status and sustained esophageal patency should be considered reference points for a successful dilatation[3]. Conversely, alkalis combine with tissue proteins and cause liquefactive necrosis and saponification, and penetrate deeper into tissues, helped by a higher viscosity and a longer contact time through the esophagus. 0000011054 00000 n Sodium hydroxide is a colorless to white liquid, and odorless. 0000001868 00000 n 1 Household stress (such as marital conflict, mental or physical illness or loss of a family member) was identified as the leading risk factor. 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. Caustic soda (or sodium hydroxide) is a chemical compound in the form of a colorless and odorless crystal powder. PMC legacy view Gupta NM, Gupta R. Transhiatal esophageal resection for corrosive injury. In contrast, ingestion in adults is more often suicidal in intent, and is frequently life-threatening. Immediate medical attention and special treatment, if necessary . In developing countries, experienced pediatric surgical centers are not widely available and this should be considered before abandoning the conservative approach of dilatation.
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