2024-05-10 06:32:23
The patient and her story
The 58-year-old woman had dissolved half a bottle of pipe-release pellets in a glass of water and drank it, she said, to draw attention to herself. As reported by the emergency physician and her colleagues, when she arrived at the emergency department of the University Hospital in Cologne, her vomit contained blood, she showed symptoms of shock and severe chest pain.
Clinical presentation and initial measurements
- In the trauma room, the patient was awake but hypotensive and in tachycardia (blood pressure: 90/70 mmHg, heart rate: 110/min), she continued to vomit mucus with some blood and to feel severe pain.
- Hoarseness, salivation, progressive swelling of the upper and lower lip.
- Lesions in the oral mucosa, swelling of the epiglottis and arytenoids during video laryngoscopy.
- Gastroscopy: extensive detachment of the mucosa of the esophagus and stomach with the presence of necrotic areas, extending to the duodenum.
- CT scan of the chest and abdomen: edematous changes in the area of the pharynx and larynx as well as the wall of the esophagus and stomach.
- Suspected aspiration pneumonia.
Development
- Intensive care, including ventilation and parenteral nutrition, and antibiotic treatment with piperacillin/tazobactam.
- Transition to normal service following five days.
- Continuation of opiate analgesia due to severe substernal pain.
- About 14 days following the event, resumption of oral hydration, careful diet for several weeks.
- Due to increasing dysphagia and progressive retrosternal pain, repeat endoscopy two months following the event: from the junction between the hypopharynx and esophagus, long-term stenosis with fibrin deposits and inflammation still florid.
- According to the authors, it was not possible to pass the stricture with the standard endoscope (diameter of regarding 8 mm).
Discussion
As Victor Suárez and colleagues explain, accidental ingestion of corrosive household substances is most commonly seen among children. In adults, it is usually a suicide attempt. The main component of pipe unblocking granules is, in addition to aluminum shavings, sodium or potassium hydroxide. By adding water, these substances formed highly caustic soda or potash lye. Furthermore, the oxidation of aluminum results in a strong release of heat.
When taken orally, both reactions caused thermal and chemical burns with the formation of so-called liquid necrosis. Contact with acids causes coagulation necrosis, where the coagulated layer prevents the development of the lesion. In liquid necrosis, the tissue becomes liquid like jelly, there is saponification of subcutaneous lipids; the damage continues into deeper layers of tissue, a process that can last a long time. It can therefore have a superficial effect initially, but can then penetrate into the deeper layers of the tissues.
The main clinical symptoms of esophageal/gastric lesions caused by release products are vomiting of blood and very severe pain in the throat and chest.
However, symptoms and possible visible burns generally correlate poorly with the degree of esophageal/gastric injury, especially in children. This is why the emergency physician and his colleagues recommend that in case of suspicion of oral poisoning by a product to unclog the tubes, a gastroscopy should be performed quickly, even in the absence of external signs.
Emergency advice
According to the authors, the face, mouth and eyes should be immediately rinsed with plenty of water. In conscious patients, efforts should be made to continue flushing out any granules still present in the esophagus by drinking water. However, the usefulness of a gastric tube is controversial due to the risk of perforation. Under no circumstances should you induce vomiting. A quick gastroscopy is indicated to try to eliminate toxins and assess the extent of the burns. Since glottisedema can also occur with a risk of life-threatening airway obstruction, indications for intubation should be made early. General use of cortisone is not recommended for adult patients. In children with moderately severe chemical burns, 3 days of cortisone treatment reduced the incidence of strictures, but prolonged steroid treatment is also not recommended in pediatric patients.
This case study was originally published on Univadis.de.
1715327999
#Case #study #product #unclog #pipes #consequences
