LITERATURE REVIEW

CAUSTIC
POISONING INGESTION
YENI HARYANI

PEDIATRIC EMERGENCY
SUBDIVISION
1

INTRODUCTION

poisoning ingestion is still
major problem in society
AAPC, 1998, 1.08 million
ingestion substances < 6yr.
common agents :household product,
industrial cleaners, beauty product,
petroleum, pesticida, opium, plant,
herbal, medicine, hydrocarbon.

2

Caustic
agents

Alkaline

Acid

pH>7

pH<7

Accepting proton

Donating proton

3

Epidemiology US Poison centre Italy East Asia •200.000 cases/yr •Household product •148 children Dec 2005-July 2008 •Glacial acetic acid 4 .

Insidens Children <5yr Teenager & adult •Accidental poisoning •Liquid form • Intentional poisoning. suicide attempt • Mortality & morbidity inscrease 5 .

battery  Nitric acid. drain cleaner. laboratory equipment cleaner  Acetic acid: decinfectant 6 . clor solution Amonia: cleaner. metal cleaner. clini tablet. KOH : drain cleaner. glass cleaner  HCl: toilet cleaner. oven cleaner. swimpool cleaner. plester Na hipochlorite. detergent Posphat: detergent Acid  H2SO4: toilet bowl cleaner. Ca hipochlorite: bleaches. posfor acid: metal cleaner  HF acid: rust cleaner.CAUSES Alkaline  NaOH. ceramic cleaner. dental cleaner CaOH: cement.

PATHOPHYSIOLOGY Alkaline ingestion Tissue injury : liquefactive necrosis safonification of fats & protein degradation deep penetration injury Oesophagus is the most involved organ Acid Ingestion Tissue injury : Necrosis coagulation protein denaturation superficial tissue eschar and coagulation  abdomen is the most involved organ 7 .

abdominal pain. vomiting Acute peritonitis haematemesis Syok.CLINICAL MANIFESTATION History Dyspnea. odinofagia Physical examination Airway obstruction Burns on orofaring drooling. disfagia. nausea. Chest pain. mental abnormal 8 .

creatinin. urine output 9 . BGA Liver function test. DIC test Urinalysis. electrolyte.WORK UP Laboratory:  pH of substance ingestion  pH of saliva CBC. BUN.

Radiologyc Examination  chest x-ray : pneumomediastinum. foreign bodies. foreign bodies Plain abdomen : pneumoperitoneum. pneumoperitoneum. ascites. pleural effusion. perforation CT-scan : extralumen air 10 .

Endoscopy Timing : •1st: 24 hour after ingestion •2nd: 3-4 weeks later Classification Indication 11 .

Diagnosis Differential diagnosis • History • Physical examination • Supportive examination • Burn injury • Gastrointestinal bleeding 12 .

duration of contact • Do not to induce emesis or neutralizir • Active charcoal is not efective • Dilution 13 .PREHOSPITAL MANAGEMENT • Identification of ingestion product • Timing of treatment.

cricotiroitomi intubation Gastric Emptying & Decontamination •Not recomended: induce vomiting & gastric lavage •Suction via NGT •Active charcoal: relatif contraindication 14 .HOSPITAL MANAGEMENT Airway Control •Airway and mental status assesment •Endotrachea.

. blood 15 .. Hospital Management dilution Do not do neutralisir Intravenous access..

. H2Blocker. PPI Medication Indication Analgesic narcotic 16 ...hospital management Cortico steroid antibiotic drugs Antacida.

Hospital management Nutrition • Gastrostomy • Parenteral nutrition: CVP EBD. Antifibrotic agent • Inhibition of fibroblast. stenting Mitomycin C • Topical. bouginase esophageal • 4-6 wks after ingestion • Pneumatic dilatation... decreasing scarring 17 ..

MANAGEMENT SUMMARY 18 .

Airway obstruction C O perforation M E P A L R I L C Y A T I O N Mediastinitis pleuritis Gastrointesti nal bleeding Cardiac arrest syok peritonitis 19 .

Late Complication Esophageal strictur Squamous cell carcinoma 20 .

symptomatic.PROGNOSIS Tissue injury Treatment : basic. supportive treatment Anticipate complication Strictur esophagal: Squamous cell carcinoma Death 21 .

peritonitis Endoscopy : indication Poison Control Centre Psikiatri : suicide attempt 22 .CONSULTATION Surgery: perforation.

PREVENTION Parents : Industrial corporation: Caustic agents store in child Reduced resistant containers concentration of household product 23 .

CONTROVERSION •Steroid •Antibiotic •Endoscopy 24 .

MANAGEMENT PATHWAY Suspected poisoning And treatment Poison Control Centre Indonesia 25 .

treatment. 26 . Stepwise care approach include: diagnosis.SUMMARY Caustic Poisoning Ingestion may cause devastating injury in children. and anticipate complication are helpful in successful management.

THANK YOU 27 .

Endoscopic view of the esophagus in a patient who ingested hydrochloric acid 28 .

hyperemic Grade IIA: superficial ulceration. scattered areas of necrosis Grade IIIB: extensive necrosis 29 . haemorrhage Grade IIB: IIA+ circumferential ulceration Grade IIIA: small. erotion.Zargar Endoscopic Classification Scheme for Caustic mucosal Injury Grade 0 :Normal Grade I: edema. whitish membran. exudates. blister.

Indication for Endoscopic • Small children • Simptomatic older children & adult • Patient with altered mental status • Patient with intentional ingestion • Patient with potential for significant injury 30 .

Medical therapy in caustic ingestion 31 .

Management of caustic injury 32 .

2yr old boy with focal esophageal stricture after glacial acetic acid of ingestion 33 .

id  Surabaya Poison Information Health Service . Badan POM/ Bidang Informasi Keracunan.go.Poison control centre in Indonesia  Bandung Poison Information Health Service . Jl. Badan POM. 25 Bandung Director: Dra Hj Sri Sulastri Telephone: +62 (0)22 421 2800  Jakarta National Poisons Information Centre (NPIC) Sentra Informasi Keracunan.West Java Jl Pasteur No.East Java Jl Ahamad Yani No.id or informasi@pom. 118 Surabaya Director: Dra Lilik Suharti Telephone: +62 (0)31 828 0660 Fax: +62 (0)31 828 0660 34 . Percetakan Negara No. 23 Jakarta 10560 Head: Dra Daya Sundari S Telephone: +62 21 425 9945 Emergency telephone: +62 813 1082 6879 Fax: +62 21 4288 9117 E-mail: pusatiomker@cbn.net. Pusat Informasi Obat dan Makanan.

Gastrostomy 35 .

Gastrostomy 36 .