Esophageal mucosa exfoliation induced by oxalic acid poisoning: A case report

Abstract

Abstract. This study reports the case of a 44-year-old woman with oral oxalic acid poisoning. As the illness progressed, the patient exhibited severe metabolic acidosis, large-area esophageal mucosa injury and acute kidney injury, which required dialysis. A guide wire slipped out of position during the process of hemodialysis and moved back and forth in the veins, but was removed successfully by interventional endovascular treatment. However, the patient's esophageal mucosa exfoliated, which lead to severe benign esophageal stenosis and dysphagia. Balloon distention was conducted twice in the upper digestive tract using X-ray location in combination with a dumb-bell bladder and interventional wire. The patient exhibited convulsions, shock, embolism and loss of consciousness while undergoing the second balloon distention procedure. Following symptomatic treatment, the patient eventually remained in a stable condition, the digestive tract expansion procedure was not resumed and a jejunostomy was performed in order to facilitate enteral nutrition, which was administered via the jejunum and had little stimulatory effect on the pancreas. Following various treatments, the patient's condition improved markedly, with renal function returning to normal. IntroductionOxalic acid (OA), otherwise known as ethane diacid, is the most simple binary acid. OA exerts marked corrosive and toxic effects, and is commonly used in industry for metal polishing, cleaning and bleaching. OA can cause burns and poisoning, and although industrial cases are extremely rare, OA poisoning is being recognized as an emerging epidemic in certain rural communities as it is a component of widely produced household laundry detergents (1). The toxic effects of OA are primarily described in associated with ethylene glycol poisoning (2), as OA is a metabolite of ethylene glycol. As a final metabolic product, OA is ubiquitously present in plants, fungi and animals. Previously reported cases of isolated OA poisoning involve the consumption of food, medications and plants that contain the compound, such as star fruit and ascorbic acid (3). As OA is the primary component of certain domestic cleaning products, oral OA poisoning cases are not uncommon. Direct intoxication with OA is a relatively frequent occurrence, due to OA being a primary component of some household laundry detergents, and reports of the toxicological effects of OA poisoning in humans are not uncommon, including gastrointestinal effects, hypocalcemia secondary to calcium oxalate crystal formation and renal toxicity (4-6). However, it is relatively uncommon for exfoliation of the esophageal mucosa to be caused by OA poisoning. The present study reports a case of oral OA poisoning in a woman that developed large-area esophageal mucosa injury and acute kidney injury following self-ingestion of OA. The study was approved by the ethics committee of Qilu Hospital of Shandong University (Jinan, China), and informed consent was obtained from the patient. Case reportA 44-year-old woman oral consumed...