Endoscopic Findings and Outcome in Caustic Ingestion of Acid and Alkaline Agents in Adults

Hollenbach, Marcus; Tünnemann, J; Struck, Matthias; Feisthammel, Jürgen; Schlosser, T.; Schaumburg, Tiffany; Mössner, J; Hoffmeister, Albrecht

doi:10.1055/s-0038-1637508

Cited by 2 publications

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“…We report the only two adult cases of NH 4 OH ingestion described in literature at the Peradeniya Teaching Hospital in Sri Lanka. Although NH 4 OH ingestion is rare, ingestion of other alkali are common and can acutely present with severe upper gastrointestinal mucosal injury leading to perforation, mediastinitis and peritonitis 2 3. In contrast to acid ingestion which causes coagulative necrosis with eschar formation, alkali ingestion results in liquefactive necrosis of all layers of the gastrointestinal tract 4 5.…”

Section: Introductionmentioning

confidence: 99%

Two rare case reports of ingestion of ammonium hydroxide and novel study of gastrointestinal toxicity

Perananthan

Wijerathna

Nagaratnam

et al. 2019

BMJ Open Gastroenterol

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ObjectiveWe report the only two adult cases of NH4OH ingestion described in literature at the Peradeniya Teaching Hospital in Sri Lanka. Both cases showed clinical evidence of gastrointestinal toxicity and using intestinal fatty acid binding protein (IFABP), a novel biomarker, we attempted to quantify the extent of enterocyte damage. Procalcitonin was also measured as a maker of bacterial sepsis to ascertain whether there was a link between enterocyte damage and infection secondary to bacterial translocation.CasesA 45-year-old, previously well man was brought in by family with a reduced level of consciousness after ingestion of an unknown quantity of industrial NH4OH (29% solution) with suicidal intent. Peak IFABP and procalcitonin levels were 1274 pg/mL and 2.0 ng/mL, respectively, 7.7 hours following presumed ingestion. A 23-year-old, previously well woman presented 24 hours after consuming 100 mL of NH4OH (5.4% solution) used as a cleaning product. She presented with ongoing vomiting and oropharyngeal pain. Her peak IFABP and procalcitonin levels were 865 pg/mL and 5.8 ng/mL, respectively, 27.2 hours following ingestion.ConclusionWe report the only two adult cases of NH4OH ingestion and describe severe gastrointestinal damage both clinically and biochemically. IFABP, currently only a marker used in research settings, was elevated in both cases but only marginally below that of levels seen in mesenteric ischaemia (levels greater than 1300 pg/mL). The use of a marker for enterocyte damage especially in ingestion of caustic solutions can allow clinicians to monitor progress, predict complications and evaluate the need for further invasive procedures.

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Section: Introductionmentioning

confidence: 99%

Two rare case reports of ingestion of ammonium hydroxide and novel study of gastrointestinal toxicity

Perananthan

Wijerathna

Nagaratnam

et al. 2019

BMJ Open Gastroenterol

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“…According to our score, integrating mucosal assessment with the analytical expression of the transmural lesion improves the ability to identify cases with worse evolution and overcomes the limitations of an evaluation based only on endoscopy. Since leukocytosis and acidosis are very effective in identifying severe cases, we recommend performing these analysis whenever clinical complications are suspected (impaired clinical status, respiratory involvement or severe endoscopic injury).Several studies have evaluated the predisposing factors for poor evolution after caustic damage[26][27][28], the impact of symptoms on prognosis[1][2][3][4][5][6][7][8][9][10][11]14,29] and the predictive ability of endoscopy [2,23,30-34]. However, several of these studies contain methodological limitations, due to their retrospective design, possible selection biases (some studies include only admitted patients or those who have undergone endoscopy), and the fact that most of their results have not 15 Accepted Manuscript Accepted Manuscript been validated.…”

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Caustic ingestion: development and validation of a prognostic score

et al. 2020

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Background and study aims: Caustic ingestion is a potentially severe condition; early identification of poor outcome is essential for improve management, but prediction based only on endoscopy can overestimate its severity. The aim of the study was to develop and validate a prognostic score. Patients and methods: A prospective cohort study was designed to include all patients older than 15 years consecutively attended in our tertiary care hospital between 1995 and 2017. Adverse outcome was defined by any of the following conditions: intensive care unit admission, urgent surgery or death. The predictive value of clinical, analytical and endoscopic variables was assessed in a first cohort of cases (derivation cohort) and a prognostic score based on the resulting risk factors was developed by logistic regression; internal validation (bootstrapping) was performed and then external validation was checked in an independent sample of patients (validation cohort). Results: 469 cases were included, 265 in the derivation cohort and 204 in the validation one. Ingestion of acid substances (OR 3.13, 95%CI:2.33-4.21), neutrophil count (OR 1.05, 95%CI:1.04-1.06), metabolic acidosis (bicarbonate value, OR 0.82, 95%CI:0.78-0.85) and endoscopic injury (OR 3.81, 95%CI:3.35-4.34) were independent risk factors of poor outcome. The prognostic score based on these variables provided better accuracy than endoscopy alone (p=0.038), with high sensitivity, specificity, positive, negative predictive values (93.3%, 92.7%, 72.7%, 98.5%, respectively) and area under the curve (0.976, 95%CI:0.973-0.976, p<0.001). Conclusions: This score allows a reliable prognosis of caustic ingestion and is more accurate than the classical evaluation based only on endoscopy.

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Endoscopic Findings and Outcome in Caustic Ingestion of Acid and Alkaline Agents in Adults

Cited by 2 publications

References 0 publications

Two rare case reports of ingestion of ammonium hydroxide and novel study of gastrointestinal toxicity

Two rare case reports of ingestion of ammonium hydroxide and novel study of gastrointestinal toxicity

Caustic ingestion: development and validation of a prognostic score

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