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Consequences of caustic ingestions in children
M Nuutinen1, M Uhari, T Karvali
1Department of Pediatrics, University of Oulu, Finland.
Acta Paediatrica (Oslo, Norway : 1992)
|November 1, 1994
Summary
Caustic ingestion in children is changing, with acids causing more esophageal burns and scars than alkalies. Prolonged drooling and dysphagia predict scarring, suggesting selective esophagoscopy is appropriate.
Area of Science:
- Pediatric Gastroenterology
- Toxicology
- Public Health
Background:
- Caustic ingestion in children presents evolving challenges.
- Lye availability has decreased due to legislation, altering ingestion patterns.
- Household chemicals, particularly acids like vinegar, are now more common ingestants.
Purpose of the Study:
- Evaluate the long-term consequences of pediatric caustic ingestion.
- Determine indications for esophagoscopies, radiographic, and laboratory examinations.
- Analyze the changing landscape of caustic ingestions in children.
Main Methods:
- Retrospective analysis of 98 pediatric patients (age < 15) treated between 1976-1990.
- Review of ingested substances, clinical presentation, and diagnostic procedures.
- Statistical analysis of outcomes, including esophageal burns, scars, and hospitalization duration.
Main Results:
- Acids caused more esophageal burns (39.1%) and scars (7.4%) than alkalies (14.7% and 4%, respectively).
- Prolonged drooling and dysphagia (12-24h) were highly sensitive and specific predictors of esophageal scar formation.
- Radiographic examinations and leukocyte counts were not valuable in predicting esophageal burns or scars.
Conclusions:
- The pattern of caustic ingestion has shifted towards acids, necessitating re-evaluation of management strategies.
- Vinegar should be recognized as a potent caustic agent, requiring appropriate packaging and warnings.
- Selective use of esophagoscopy based on clinical signs like drooling and dysphagia is recommended, avoiding routine procedures.