[Current treatment of poisoning by ingestion of caustic substances]. 1992

H Lambert, and D Renaud, and M Weber, and P Bauer
Centre Anti-Poison de Nancy, Hôpital Central, France.

Lesions by ingestion of corrosive substances had so far been treated at the time of sequelae. In the seventies several events modified deeply the epidemiology and the early care of these poisonings. At that time household products like highly concentrated basic and acid substances and oxidizing agents were distributed and led to an increase of the number and the severity of these intoxications. In the same time, fiberoptic endoscopy of the digestive tract played a leading part to evaluate the diagnosis and the prognosis of these poisonings at an early stage, and thus, with accurate intensive care and digestive surgery contributed to generate appropriate guidelines, according to the severity. The first step of the treatment is fasting, fluid replacement and analgesic if required. A full examination must be performed, especially in the throat even if there is no strong correlation between early clinical signs and the severity of the lesions; blood samples must be obtained to look for metabolic acidosis, hyperleukocytosis hemolysis and consumption coagulopathy which could be better indicators of the severity. Fiberoptic endoscopy of the upper digestive tract should be performed as soon as the physical and psychological patient's condition is stable; if possible before the twelfth hour and no more late than the twenty-fourth hour. It should determine the lesions: type, range and grade according to Quincy's classification modified by Mongon and Di Constanzo. Survival and healing of "extremely severe" grade intoxication can only be obtained through a surgical intervention within the first hours; a laparotomy will indicate the depth of the lesions, which is not determined by endoscopy, and will consist of Celerier's stripping method and if necessary a gastrectomy, more seldom a cephalic duodeno-pancreatectomy. Only the surgical excision of necrotic tissues can prevent the occurrence of lethal complications like oesophageal or gastric perforations and septic shocks. The analysis of the literature from 1975 up to now gives us information on the methods and the results of these different therapeutic approaches.

UI MeSH Term Description Entries
D002057 Burns, Chemical Burns caused by contact with or exposure to CAUSTICS or strong ACIDS. Chemical Burns,Burn, Chemical,Chemical Burn
D002424 Caustics Strong alkaline chemicals that destroy soft body tissues resulting in a deep, penetrating type of burn, in contrast to corrosives, that result in a more superficial type of damage via chemical means or inflammation. Caustics are usually hydroxides of light metals. SODIUM HYDROXIDE and potassium hydroxide are the most widely used caustic agents in industry. Medically, they have been used externally to remove diseased or dead tissues and destroy warts and small tumors. The accidental ingestion of products (household and industrial) containing caustic ingredients results in thousands of injuries per year. Caustic,Corrosive,Corrosives
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D004947 Esophagus The muscular membranous segment between the PHARYNX and the STOMACH in the UPPER GASTROINTESTINAL TRACT.
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults

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