[Clinical-epidemiological characteristics in caustics ingestion patients in the Hipólito Unanue National Hospital]

The ingestion of caustic substances represents a serious problem, often with devastating consequences on the esophagus and the stomach.

1) Determine the main caustic substance ingested and the lesions on the esophageal-gastric mucose. 2) Find out the clinical-epidemiological characteristics of these patients in our hospital.

45 inpatients at the Hipólito Unanue National Hospital were evaluated between 1996 and 2001, 29 female patients (64.4%) and 16 male patients (35.6%) with an average age of 28 years in a range between 15 and 60 years. The caustic substances ingested were: bleach, 30 patients (66.7%), muriatic acid (hydrochloric acid) 13 patients (28.9%), nitric acid and caustic soda, one patient each (2.2%). Among the women: 24 patients ingested bleach (82.7%) 4 patients, muriatic acid (13.7%) and one patient, caustic soda (3.4%). Among the men: 9 patients took muriatic acid (56.3%) 6 patients, bleach (37.5%) 1 patient, nitric acid (6.25%); 29 patients ingested the caustic substances in pure form (64.4%) and 16 patients diluted with other substances: water, soft or alcoholic drinks, oatmeal (35.5%). The time passed between the ingestion and medical attention was of 104 minutes, with a range of 15 to 360 minutes. The average of total ingested solution was 73 ml., ranging between 10 ml and 170 ml. The reason for the ingestion was a conflict with their spouse, 24 patients (53.4%) family conflict, 13 patients (28.9%) accident, 4 patients (8.9%) psychiatric problems, 3 patients (6.7%) and a monetary factor, 1 patient (2.2%). The signs and symptoms when admitted into the hospital were: abdominal pain, 31 patients (68.9%) nausea, 22 patients (48.9%) vomit, 21 patients (46.7%) mouth cavity pain, 19 patients (42.2%) dysphagia, 14 patients (31.1%) sialorrhea, 14 patients (31.1%) odynophagia, 13 patients (15.6%) sensory disorder, 7 patients (15.6%) dysphonia, 3 patients (6.7%) and cephalea, 1 patient (2.2%). Oral compromise was: normal in 11 patients (24.4%) congestion in 23 patients (51.1%) and erosions in 11 patients (24.1%). Endoscopic lesions found were: grade 0 in 6 patients (13.3%) grade 1 in 21 patients (46.7%) Grade 2A in 7 patients (15.6%) Grade 3B in 2 patients (4.4%).

Adolescents and young adults are the age groups which most suffer of this pathology. Bleach is the most ingested caustic substance (66.7%). Women have a higher risk of ingesting a caustic substance (64.4%). Caustic substances are mostly ingested pure (64.4%). Conjugal conflicts are the main reason for caustic ingestion. Clinical symptoms vary, with abdominal pain being the main discomfort among these patients. Oropharyngeal congestion is the most frequent finding. Esophageal-gastric mucose edema and hyperemia (Zargar 1) are the endoscopic lesions mostly found.