Initial Signs and Symptoms as Prognostic Indicators of Severe Gastrointestinal Tract Injury Due to Corrosive Ingestion

Havanond, Chittinad; Havanond, Piyalamporn

doi:10.1016/j.jemermed.2007.02.062

Cited by 63 publications

(54 citation statements)

References 10 publications

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“…However, in a similar study by Chen et al [20] found that there was no statistically significant difference in terms of WBC and CRP values between high-grade and low-grade injuries. In another study in patients with median age 22 years (min:2-max:61), WBC count was higher in high-grade injured patients [21]. Kaya et al and Chen et al reported that WBC count could not predict the severity of esophageal injury in these studies; however Hovanond et al stated that WBC count was an independent predictor for high-grade injury.…”

Section: Discussionmentioning

confidence: 93%

Neutrophil to Lymphocyte Ratio as a Predictor of Endoscopic Damage in Caustic Injuries

Uyar¹,

Kök²

2017

J Clinic Toxicol

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Context: The endoscopic degree of injuries is the main finding for further management of caustic ingestions. However, if endoscopy cannot be performed quickly, clinicians decide on treatment and follow-up goals according to the signs and symptoms of the patient. The aim of this study was to determine the association of white blood cells (WBC), C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) with the degree of caustic injury and to evaluate whether NLR is able to predict the severity of injuries. Materials and methods:A retrospective evaluation was made of a total of 190 patients with a mean age of 38.6 years. WBC, neutrophil, lymphocyte and CRP values and endoscopic findings of all patients at hospital admission were retrieved from hospital files. The association between WBC, NLR, CRP and endoscopic findings was evaluated.Results: Endoscopy was normal in 28 of 119 patients (23.5%) and most patients (42 of 119 (35.3%) had only gastric involvement. NLR was significantly higher in patients with injuries than normal patients (p=0.010), whereas WBC and CRP not. NLR was also significantly higher in patients with both esophagus and gastric injuries compared to patients with no organ involvement (p<0.001). NLR, WBC and CRP were weakly correlated to the grade of involvement. In the ROC analysis, the AUC value was 0.914 (95% CI (0.85-0.96, p<0.001)) and the cut-off value for NLR was 8.71 with sensitivity of 90% and specificity of 91.7% for discriminating injuries as grade 0-1-2 from 3-4. Conclusions:Higher NLR values showed widespread and severe involvement of caustic ingestion. NLR also seems to be a more reliable method to make a distinction between severe and mild injuries. It is an easily derived and inexpensive marker of inflammation and might guide the management of patients before endoscopic evaluation in emergency departments.

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Section: Discussionmentioning

confidence: 93%

Neutrophil to Lymphocyte Ratio as a Predictor of Endoscopic Damage in Caustic Injuries

Uyar¹,

Kök²

2017

J Clinic Toxicol

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“…One study suggested that drooling, vomiting, and stridor could be used to predict esophageal injury, while another found that drooling, buccal mucosal burns, and white blood cell count were significant independent predictors of the degree of gastrointestinal injury (13)(14)(15). Other studies, however, could not identify signs or symptoms that could be used to reliably predict degree of injury [16,17].…”

Section: Discussionmentioning

confidence: 99%

“…The timing of the EGD is controversial, with some experts recommending performing it emergently while others suggesting waiting 48-72 hours to assess the full extent of the injury [13,14,19]. Endoscopic grading of caustic injuries is based on 4 grades: Grade 1, edema and erythema; Grade 2 (a indicates linear, b indicates circumferential) hemorrhages, erosions, blisters, superficial ulcers, and exudates; Grade 3, multiple deep brownish-black or gray ulcers; Grade 4, perforation [14,19,20].…”

Section: Discussionmentioning

confidence: 99%

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A complicated hospitalization following dilute ammonium chloride ingestion

et al. 2009

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Introduction: Unintentional ingestions of dilute (<7.5%) cleaning solutions containing ammonium chloride typically do not cause serious harm. We present a case of an intentional ingestion of a dilute ammonium chloride solution resulting in significant morbidity.Case Report: A 60-year-old woman with bipolar disorder presented one hour after an intentional ingestion of approximately 15 fluid ounces (500 mL) of an algae and odor humidifier treatment containing a total of 2.25% ethyl ammonium chloride. Initial complaints included nausea with a single episode of nonbilious, nonbloody emesis, mild shortness of breath, and chest and epigastric pain. Physical exam was remarkable for bilateral wheezing and epigastric tenderness. An emergent endoscopy demonstrated a Grade 2b caustic injury in the esophagus and a Grade 3b injury in the stomach. Due to persistent cough, copious oral secretions, and worsening hoarseness, the patient was intubated and admitted to the ICU. Her course was complicated by mild hypotension, nonanion gap metabolic acidosis, and oliguria treated successfully with intravenous (IV) fluids. She also developed bilateral pneumonias later in the hospital course. Bedside bronchoscopy showed laryngeal edema and mucosal injury to the segmental level. The patient underwent tracheostomy on hospital day 6. An upper GI swallow study revealed poor esophageal motility in the mid-to lower third of the esophagus. The patient gradually tolerated oral fluids and on hospital day 20 had her tracheostomy tube removed. The patient was subsequently transferred to the psychiatric ward on hospital day 22.Conclusion: Intentional ingestions of dilute ammonium chloride solutions can cause serious injury to the gastrointestinal tract and pulmonary systems, which can result in a complicated and prolonged hospitalization.

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“…Dans la série Havanond et Havanond [28], l'absence d'hypersalivation, de dysphonie, de défense abdominale et de brûlures oropharyngées était corrélée avec des brûlures caustiques digestives de bas grades.…”

Section: Discussionunclassified

Corrélation toxique, clinique et endoscopique des lésions digestives caustiques chez l’adulte

et al. 2011

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Objectifs : La gravité d'une ingestion caustique est difficile à prédire. Le but de cette étude était d'établir une corrélation entre les caractéristiques de l'ingestion, la symptomatologie clinique et les lésions endoscopiques qui résultent d'une ingestion caustique. Patients et méthodes : Dans cette étude prospective monocentrique, tous les patients adultes pris en charge entre 2006 et 2008 pour une ingestion caustique dont les détails étaient connus ont été inclus. On a procédé à des corrélations statistiques entre les caractéristiques de l'ingestion, avec les diffé-rents symptômes cliniques qui en découlent et les résultats endoscopiques. Résultats : Trois cent quatorze cas d'ingestions caustiques ont été colligés, d'âge moyen de 28,12 (15 à 79 ans). Le caractère volontaire de l'ingestion était associé à une quantité ingérée significativement plus importante (p = 0,01). Le type acide du caustique ingéré était un facteur de risque (FDR) de survenue de dysphagie (48,8 % ; p = 0,02), d'hématémèse (61,2 % ; p < 0,0001), de péritonite (78,3 % ; p = 0,002), d'oedème laryngé (p = 0,002) et de lésions endoscopiques de stade IV. La survenue d'une dysphagie (73,7 % ; p = 0,0048), d'une hématémèse (85,2 % ; p < 0,0001), d'une détresse respiratoire (91,7 % ; p = 0,001) ou de lésions ORL (72,8 % ; p = 0,0002) étaient des facteurs prédictifs de lésions endoscopiques sévères. Un tiers des patients sans symptôme avaient, malgré tout, des lésions endoscopiques sévères. Conclusion : En cas d'ingestion caustique, la nature acide du produit et la présence d'une dysphagie, d'une hématémèse ou de brûlures ORL sont des facteurs prédisant l'existence de lésions endoscopiques sévères et doivent inciter à une prise en charge urgente des patients en réanimation. L'existence de lésions endoscopiques sévères chez un tiers des patients sans symptômes impose malgré tout la réalisation systématique d'une endoscopie rapide chez tous les patients. Pour citer cette revue : Acta Endosc. 41 (2011). Mots clés Produit caustique · Ingestion · EndoscopieAbstract Objectives: The severity of caustic ingestion is difficult to predict. The aim of this study was to establish a correlation between the characteristics of ingestion, clinical symptoms and endoscopic lesions which result from caustic ingestion. Patients and methods: In this monocentric prospective study, all adult patients treated between 2006 and 2008 for a caustic ingestion whose details were known were included. We proceeded to statistical correlations between the characteristics of ingestion and different clinical symptoms which result from this and the results of endoscopy. Results: Three hundred fourteen cases of caustic ingestion were collected, with a mean age of 28.12 years (15-79 years). A suicidal ingestion was associated with a significantly greater quantity of corrosive substance (P = 0.01). The type of caustic introduced was a risk factor for dysphagia (48.8%; P = 0.02), haematemesis (61.2%; P < 0.0001), peritonitis (78.3%; P = 0.002), laryngeal oedema (P = 0.002) and several en...

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Initial Signs and Symptoms as Prognostic Indicators of Severe Gastrointestinal Tract Injury Due to Corrosive Ingestion

Cited by 63 publications

References 10 publications

Neutrophil to Lymphocyte Ratio as a Predictor of Endoscopic Damage in Caustic Injuries

Neutrophil to Lymphocyte Ratio as a Predictor of Endoscopic Damage in Caustic Injuries

A complicated hospitalization following dilute ammonium chloride ingestion

Corrélation toxique, clinique et endoscopique des lésions digestives caustiques chez l’adulte

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