Deaths related to chemical burns.

The authors present a series of 6 deaths due to the uncommon cause of chemical burns. Of the 6 deaths due to chemical burns, 4 deaths were due to ingestion of a chemical, 1 death was caused by chemical burns of the skin, and 1 death resulted from rectal insufflation of a chemical. Seven additional cases where chemical burns may have been a contributing factor to the death or an incidental finding are also presented. Four cases are related to an incident involving chemical exposure during an industrial explosion. Three cases involve motor fuel burns of the skin. Two cases concern a plane crash incident, and 1 case involved a vehicular collision. Cases are derived from the records of the Dallas County Medical Examiner's Office and those of the authors' consultation practices. Each of the cases is presented, followed by a discussion of the various mechanisms of chemical injury.

Ingestion de cáustico en niños: experiencia de 5 años en el Hospital Dr. Miguel Pérez Carreño / Caustic ingestions in children: experience of fine years in the Hospital Dr. Miguel Pérez Carreño

Se estudiaron 187 pacientes, entre 2-72 meses, 104/187 (55.61 por ciento) varones y 83/187 (44.38 por ciento) hembras. 173/187 (92.51 por ciento) se incluyeron en el grupo A (evaluación temprana) y 14/187 (7.48 por ciento) en el B (evaluación tardía). En ambos, el cáustico ingerido principalmente fue el hidróxido de sodio (lejía) (52 por ciento y 21.43 por ciento, respectivamente). El hidróxido de sodio (soda cáustica), easy off), el amoníaco, el ácido sulfúrico y la nieve carbónica (hielo seco) son los agentes productos de lesiones más severas en orofaringe y esófago. El grupo A prersentó vómitos (48.55), sialorrea (20.23 por ciento) y disfagia (10.40 por ciento), y el B disfagia (92.85 por ciento), vómitos (57.14 por ciento) y odinofagia (35.71 por ciento). A todos se les realizó endoscopia digestiva superior, dilataciones precoces en esofagitis grado II-III y dilataciones terapaúticas en los pacientes de evaluación tardía. El grupo A se resolvió con éxito. Ningún paciente ameritó intervención quirúrgica. Concluimos, que la endoscopia digestiva superior y las dilataciones precoces constituyen un método adecuado para manejar pacientes con lesiones esofágicas por cáustica antes de las 48 horas de evolución

Development of a standardized animal model for the study of alkali ingestion.

The purpose of this study was to develop an animal model that would grade in-vivo therapeutic modality testing for caustic ingestion. Caustic substances are found in many household items (eg detergents, bleaches, pipe cleaners) and pose a serious threat to health if ingested accidentally or intentionally with resulting injuries including immediate death or chronic debilitating morbidity. This study used 5, 3.8 or 1.8% sodium hydroxide (NaOH) to determine macro/microscopic injury at 10, 30, or 60 minutes. Macroscopic grading was based on gross evaluation of denudation of mucosa, edema, hyperemia, hemorrhage, ulcerations and necrosis. Microscopic grading was based on epithelial viability, cornified epithelial cell differentiation, granular cell differentiation, epithelial cell nuclei, muscle cell viability and muscle cell nuclei. Product concentration was shown a more significant predictor of injury than time of exposure. The grading system presented should provide a reliable method of producing and grading alkaline ingestions for future treatment hypothesis testing.

Acute colitis caused by caustic products.

We report two cases of acute proctocolitis caused by rectal application of caustic products of domestic use. One 61-yr-old woman applied an ammonia solution enema; the other patient, a 63-yr-old woman, accidentally applied an enema containing lye. Both patients presented with intense anal pain, but the first patient also had abdominal pain with guarding, hematochezia, and leucocytosis. An acute proctocolitis was found at sigmoidoscopy in both patients. Only conservative and symptomatic measures were prescribed in both cases, and a clinical and endoscopic recovery was seen. In spite of persistent fibrosis in the lamina propria, no signs of stenosis were found.

Severe corrosive gastritis related to Drano: an unusual case.

A case of lye ingestion by a suicidal patient in the form of Drano in capsules is reported. Although lye ingestion usually causes lesions in the oropharynx and severe esophagitis, in our patient it produced severe gastritis with minimal esophageal findings because of the protective capsules which dissolved primarily in the stomach. Endoscopy should be the first method of evaluating patients with ingestion of corrosives, but an upper gastrointestinal (UGI) series can accurately demonstrate mucosal injury and extent of involvement. UGI can be used as an adjunct in patients incompletely examined by endoscopy and can play an important role in the follow-up examination of these patients.