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Clinical and Endoscopy Findings in Children With Accidental Exposure to Concentrated Detergent Pods
Avantika Singh1, Michael Anderson2, Muhammad A Altaf1
1Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition.
Insights
Pediatric caustic ingestion of concentrated detergent pods (CDPs) often requires evaluation. Examination findings in children with CDP exposure correlate with endoscopy results, suggesting a need for endoscopic assessment in these cases.
Area of Science:
- Pediatric Gastroenterology
- Toxicology
- Otolaryngology
Background:
- Concentrated detergent pod (CDP) ingestion is a frequent pediatric concern.
- Limited data exists on endoscopic findings in CDP ingestion, lacking established guidelines for evaluation.
Purpose of the Study:
- To review pediatric CDP exposure cases from 2010-2016.
- To correlate clinical presentation with endoscopic findings in pediatric CDP ingestion.
Main Methods:
- Retrospective review of pediatric patients with accidental CDP exposure.
- Collected data included demographics, exposure details, symptoms, physical exams, and hospital course.
- Esophagogastroduodenoscopy (EGD) and laryngoscopy-bronchoscopy findings were analyzed.
Main Results:
- 23 CDP ingestion cases identified among 83 caustic ingestions (28%).
- Gastrointestinal symptoms occurred in 91% of patients; examination findings in 35%.
- Positive EGD findings (24%) were associated with positive examination findings (80% vs. 20%, P=0.0307).
Conclusions:
- Oropharyngeal examination findings increase the likelihood of positive endoscopy results.
- Recommend endoscopic evaluation for pediatric CDP exposure patients with examination findings.
- Consider case-by-case endoscopy evaluation for other patients.
Background:
Caustic ingestion with concentrated detergent pods (CDPs) is a common problem encountered in pediatric population. There is insufficient literature about endoscopic findings in CDP ingestion and hence no current consensus or guidelines regarding the need for endoscopic evaluation.
Objectives:
To review cases of children with exposure to CDPs from 2010 to 2016 at a tertiary care children's hospital and to identifying the possibility of a correlation between clinical presentation and the endoscopic findings.
Methods:
A retrospective review identified pediatric patients with accidental caustic exposure to CDPs. Data on demographics, type of exposure, clinical symptoms, physical examination, details of the hospital course were collected. Esophagogastroduodenoscopy (EGD) findings and direct laryngoscopy-bronchoscopy findings were also collected. Descriptive statistics were computed for all demographic and clinical variables. The association between EGD findings and clinical presentation were tested using Fisher exact test.
Results:
A total of 23 (28%) cases of CDP ingestion were identified out of 83 total cases of caustic ingestion between January 2010 and June 2016. Median age was 15 months. gastrointestinal symptoms were present in 21 (91%) patients. Examination findings were present in 8 of 23 (35%) patients. EGD (done by gastroenterologists) evaluation was done in 21 (91%) patients and positive findings were seen in 5 of 21 (24%). The proportion of patients with positive examination findings was significantly higher in patients with positive EGD findings (80% vs 20%, respectively; P = 0.0307). Direct laryngoscopy-bronchoscopy (done by otolaryngologists) evaluation was done in 6 (26%) patients and positive findings were seen in 4 of 6 (67%).
Conclusions:
Our results suggest that oropharyngeal examination findings increase the likelihood of endoscopy findings; hence, we recommend endoscopic evaluation of patients who have examination findings secondary to exposure to CDPs. In other patients, it will be reasonable to evaluate the need for endoscopy on a case-by-case basis.
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