Related Experiment Videos
Consequences of caustic ingestions in children
M Nuutinen1, M Uhari, T Karvali
1Department of Pediatrics, University of Oulu, Finland.
Insights
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.
Abstract:
A retrospective analysis of 98 patients, less than 15 years of age, treated for caustic ingestion during 1976-1990 was performed to evaluate the modern consequences of caustic ingestion in children and to set indications for esophagoscopies and radiographic and laboratory examinations. Dishwasher detergents were ingested by 56 children. There were no lye ingestions, since lye has not been freely available in Finland since 1969. Household acetic acid (vinegar) was the most commonly (12/23) ingested acid. Primary esophagoscopy was performed in 79 of the 98 cases (80.6%). Esophageal burns were found in 20 patients. Acids caused burns more often than alkalies (9/23 (39.1%) versus 11/75 (14.7%); p = 0.011; 95% confidence intervals (CI) for the difference 5.6-43.3%) and acid burns more often developed into scars (7.4% versus 4%; p = 0.029; 95% CI for the difference 1.4-25.4%). The only esophageal stricture developed after ingestion of a Clinitest tablet. The mean time for hospitalization as a result of acid ingestion was significantly longer than after alkaline ingestion (3.2 (SD 3.5) days, n = 23 versus 1.5 (1.6) days, n = 75; p < 0.05; 95% CI for the difference 0.7-2.8 days). Prolonged drooling and dysphagia (12-24 h) predicted esophageal scar formation with 100% sensitivity and 90.1% specificity, but signs and symptoms did not predict esophageal burns after primary esophagoscopy. Radiographic examinations and leukocyte counts were of no value in predicting esophageal burns and scars. The panorama of caustic ingestion appears to have changed, probably due in part to the law banning sale of lye products since 1969. This type of law should be encouraged elsewhere. Acids cause even more caustic burns than alkalies. Vinegar should be regarded as a potent caustic substance and distributed in baby-safe bottles with appropriate information on its caustic nature. As severe esophageal lesions after accidental ingestion of caustic substances are now rare in children, primary esophagoscopies and hospitalization of patients are not indicated routinely. The decision on esophagoscopy can be made on the basis of drooling and dysphagia during follow-up.