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Drug induced esophageal injury
P A Perry1, B S Dean, E P Krenzelok
1Pittsburgh Poison Center, Children's Hospital of Pittsburgh, PA 15213.
Insights
A child experienced choking after ingesting half a multivitamin tablet, leading to esophageal burns. Prompt medical intervention and removal of the tablet material resulted in a full recovery within nine days.
Area of Science:
- Pediatric Gastroenterology
- Toxicology
Background:
- Accidental ingestion of medications in children can lead to serious complications.
- Multivitamin tablets, while common, pose a risk if not handled properly.
Observation:
- A 3-year-old child presented with choking, gagging, and dysphagia after ingesting half a multivitamin tablet.
- Initial examination revealed drooling and gagging, with a negative lateral neck X-ray.
- Esophagoscopy identified a granular paste consistent with the multivitamin at the cricopharyngeus and esophagus, causing significant erythema and edema.
Findings:
- The ingested multivitamin material caused severe esophageal burns, particularly at the aortic crossing and lower esophageal junction.
- Endoscopic removal of the tablet material using irrigation and forceps was successful.
- Follow-up esophagoscopy showed resolution of acute inflammation with some scarring.
Implications:
- This case highlights the potential for esophageal injury from delayed dissolution and impaction of multivitamin tablets in pediatric patients.
- Prompt diagnosis and endoscopic intervention are crucial for managing such ingestions.
- Educating caregivers on safe storage and administration of medications to children is essential to prevent adverse events.
Abstract:
A 3-year-old child weighing 16 kg was given 1/2 of a Centrum Multivitamin tablet. He began choking and gagging and was taken to an emergency department. He was alert and speaking without difficulty but was drooling, gagging, coughing, and unable to swallow. He was transferred to a children's hospital where he continued to drool but had bilaterally clear and equal breath sounds and no stridor, cough, or wheeze. A lateral neck x-ray was negative. The following morning, esophagoscopy revealed tablet material identified as a granular paste at the level of the cricopharyngeus. A large amount of the paste was encountered at the crossing of the aorta where the mucosa was extremely erythematous and edematous. Smaller amounts of the paste were observed until a larger amount was found at the lower esophageal junction. The material was removed with NSS irrigation, suction, and optical peanut forceps. A significant circumferential burn was present. Repeat esophagoscopy 7 days postingestion showed mucosal edema and some scarring. Nine (9) days postingestion the child's diet was normal and he was discharged.