Caustic Ingestion—A Forensic Overview

Byard, Roger W.

doi:10.1111/1556-4029.12741

Cited by 18 publications

(7 citation statements)

References 15 publications

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“…Although only 1 patient underwent prehospital rapid sequence intubation, the development of upper airway edema may rapidly progress after caustic contact to oropharyngeal tissue. Challenging conditions to be expected include erosive ulceration, sloughing and bleeding of oral mucosa, tongue and epiglottis, laryngopharyngeal edema, hypersalivation, subcutaneous emphysema, stridor and respiratory distress [ 1 – 6 ]. This may be reflected in 21 % of our intubated patients who presented with difficult laryngoscopy conditions.…”

Section: Discussionmentioning

confidence: 99%

“…The characteristics and pathophysiology of tissue damage after caustic ingestion depends on its nature (alkali or acid), concentration, contact time and volume of the agent, whereas the likelihood of perforation of the esophageal, gastric and intestinal wall cannot be reliably predicted. Involvement of the upper airway and subsequent respiratory failure due to laryngopharyngeal edema or tracheal aspiration belong to the most dangerous complications in the acute phase [ 1 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Acute emergency care and airway management of caustic ingestion in adults: single center observational study

Struck

Beilicke

Hoffmeister

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundCaustic ingestions are rare but potentially life-threatening events requiring multidisciplinary emergency approaches. Although particularly respiratory functions may be impaired after caustic ingestions, studies involving acute emergency care are scarce. The goal of this study was to explore acute emergency care with respect to airway management and emergency department (ED) infrastructures.MethodsWe retrospectively evaluated adult patients after caustic ingestions admitted to our university hospital over a 10-year period (2005–2014). Prognostic analysis included age, morbidity, ingested agent, airway management, interventions (endoscopy findings, computed tomography (CT), surgical procedures), intensive care unit (ICU) admission, length of stay in hospital and hospital mortality.ResultsTwenty-eight patients with caustic ingestions were included in the analysis of which 18 (64 %) had suicidal intentions. Ingested agents were caustic alkalis (n = 22; 79 %) and acids (n = 6; 21 %). ICU admission was required in 20 patients (71 %). Fourteen patients (50 %) underwent tracheal intubation and mechanical ventilation, of which 3 (21 %) presented with difficult airways. Seven patients (25 %) underwent tracheotomy including one requiring awake tracheotomy due to progressive upper airway obstruction. Esophagogastroduodenoscopy (EGD) was performed in 21 patients (75 %) and 11 (39 %) underwent CT examination. Five patients (18 %) required emergency surgery with a mortality of 60 %. Overall hospital mortality was 18 % whereas the need for tracheal intubation (P = 0.012), CT-diagnostic (P = 0.001), higher EGD score (P = 0.006), tracheotomy (P = 0.048), and surgical interventions (P = 0.005) were significantly associated with mortality.ConclusionsCaustic ingestions in adult patients require an ED infrastructure providing 24/7-availability of expertise in establishing emergent airway safety, endoscopic examination (EGD and bronchoscopy), and CT diagnostic, intensive care and emergency esophageal surgery. We recommend that - even in patients with apparently stable clinical conditions - careful monitoring of respiratory functions should be considered as long as diagnostic work-up is completed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute emergency care and airway management of caustic ingestion in adults: single center observational study

Struck

Beilicke

Hoffmeister

et al. 2016

Scand J Trauma Resusc Emerg Med

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“…Hall, et al reported 10,860 hydrochloric acid ingestions over a 7 year time frame and another 20,983 alkali ingestions over a 6 year time frame, resulting in 13 and 5 deaths, respectively [2]. In general, the mortality rate for caustic ingestion ranges from 7 to 14%, with a small-volume accidental ingestion more common in pediatric cases while adult ingestions are usually intentional and involve larger volumes [2,3].…”

Section: Discussionmentioning

confidence: 99%

Caustic Ingestions: Feel the burn

2023

austinjclincaserep

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A 56-year-old male with a past medical history of depression presented with intentional caustic ingestion. This resulted in lactic acidosis, intubation for impending airway compromise, and ultimately to gastrectomy due to the extent of the gastric injury. Caustic ingestions cause either coagulative (acidic substance) or liquefactive (alkaline substance) necrosis. Management and treatment include observation, labs, imaging, endoscopy, and may require more urgent interventions such as intubation and vasopressors. Consider consulting the local poison control center early and GI, ENT or surgery depending on severity and types of injuries. Endoscopy is useful for prognosis, but early CT imaging may also be useful and more readily available.

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“…The literature reports several cases of burns by KOH, due to cutaneous or respiratory exposure by inhalation in most of cases. The reported cases of ingestion have been lethal 1. Some cases of cutaneous burns, particularly in developing countries, are serious and reveal domestic misuse of poorly dosed solutions 2.…”

mentioning

confidence: 99%