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LITERATURE REVIEW

CAUSTIC
POISONING INGESTION
YENI HARYANI

PEDIATRIC EMERGENCY
SUBDIVISION
1

INTRODUCTION

poisoning ingestion is still


major problem in society
AAPC, 1998, 1.08 million
ingestion substances < 6yr.
common agents :household product,
industrial cleaners, beauty product,
petroleum, pesticida, opium, plant,
herbal, medicine, hydrocarbon.

Caustic
agents

Alkaline

Acid

pH>7

pH<7

Accepting proton

Donating proton

Epidemiology

US Poison
centre
Italy
East Asia

200.000 cases/yr
Household product
148 children Dec
2005-July 2008

Glacial acetic acid


4

Insidens
Children
<5yr

Teenager
& adult

Accidental poisoning
Liquid form
Intentional poisoning,
suicide attempt
Mortality & morbidity
inscrease

CAUSES
Alkaline
NaOH, KOH : drain
cleaner, oven cleaner,
clini tablet, dental
cleaner
CaOH: cement, plester
Na hipochlorite, Ca
hipochlorite: bleaches,
clor solution
Amonia: cleaner,
detergent
Posphat: detergent

Acid
H2SO4: toilet bowl cleaner,
drain cleaner, metal cleaner,
battery
Nitric acid, posfor acid:
metal cleaner
HF acid: rust cleaner,
ceramic cleaner, glass
cleaner
HCl: toilet cleaner,
swimpool cleaner,
laboratory equipment
cleaner
Acetic acid: decinfectant

PATHOPHYSIOLOGY
Alkaline ingestion
Tissue injury :
liquefactive necrosis
safonification of
fats & protein
degradation
deep penetration
injury
Oesophagus is the
most involved organ

Acid Ingestion
Tissue injury :
Necrosis coagulation
protein
denaturation
superficial tissue
eschar and
coagulation
abdomen is the most
involved organ

CLINICAL MANIFESTATION

History
Dyspnea, disfagia,
odinofagia

Physical
examination
Airway obstruction
Burns on orofaring

drooling,

Chest pain,
abdominal pain,
nausea, vomiting

Acute peritonitis
haematemesis
Syok, mental abnormal
8

WORK UP
Laboratory:
pH of substance ingestion
pH of saliva
CBC, electrolyte, BUN,
creatinin, BGA
Liver function test, DIC test
Urinalysis, urine output
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Radiologyc Examination
chest x-ray :
pneumomediastinum, pleural
effusion, pneumoperitoneum,
foreign bodies
Plain abdomen :
pneumoperitoneum, ascites,
foreign bodies, perforation
CT-scan : extralumen air
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Endoscopy

Timing :
1st: 24 hour after ingestion
2nd: 3-4 weeks later

Classification
Indication
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Diagnosis

Differential
diagnosis

History
Physical examination
Supportive
examination

Burn injury
Gastrointestinal
bleeding
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PREHOSPITAL MANAGEMENT
Identification of ingestion product
Timing of treatment, duration of contact
Do not to induce emesis or neutralizir
Active charcoal is not efective

Dilution
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HOSPITAL MANAGEMENT
Airway Control
Airway and mental status
assesment
Endotrachea, cricotiroitomi
intubation

Gastric Emptying &


Decontamination
Not recomended: induce vomiting & gastric
lavage
Suction via NGT
Active charcoal: relatif contraindication
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... Hospital Management


dilution

Do not do neutralisir

Intravenous access,
blood
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...hospital management
Cortico
steroid

antibiotic

drugs
Antacida,
H2Blocker, PPI

Medication

Indication

Analgesic
narcotic
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... Hospital management


Nutrition

Gastrostomy
Parenteral nutrition: CVP

EBD,
bouginase
esophageal

4-6 wks after ingestion


Pneumatic dilatation,
stenting

Mitomycin C

Topical, Antifibrotic agent


Inhibition of fibroblast,
decreasing scarring
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MANAGEMENT SUMMARY

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Airway
obstruction

C
O

perforation

A L
R

L C
Y A

T
I
O

Mediastinitis
pleuritis
Gastrointesti
nal bleeding

Cardiac
arrest

syok
peritonitis

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Late
Complication
Esophageal
strictur

Squamous
cell
carcinoma
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PROGNOSIS

Tissue injury
Treatment : basic,
symptomatic,
supportive
treatment
Anticipate
complication

Strictur
esophagal:

Squamous cell
carcinoma

Death

21

CONSULTATION

Surgery: perforation, peritonitis


Endoscopy : indication
Poison Control Centre
Psikiatri : suicide attempt
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PREVENTION
Parents :

Industrial
corporation:

Caustic agents
store in child
Reduced
resistant containers concentration of
household product
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CONTROVERSION
Steroid
Antibiotic
Endoscopy
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MANAGEMENT PATHWAY
Suspected poisoning
And treatment

Poison Control Centre

Indonesia
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SUMMARY
Caustic Poisoning Ingestion may
cause
devastating
injury
in
children. Stepwise care approach
include: diagnosis, treatment, and
anticipate complication are helpful
in successful management.
26

THANK YOU
27

Endoscopic view of the


esophagus in a patient who
ingested hydrochloric acid
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Zargar Endoscopic Classification Scheme for Caustic mucosal


Injury

Grade 0 :Normal
Grade I: edema, hyperemic

Grade IIA: superficial ulceration,


exudates, whitish membran, blister,
erotion, haemorrhage
Grade IIB: IIA+ circumferential ulceration

Grade IIIA: small, scattered


areas of necrosis
Grade IIIB: extensive necrosis
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Indication for Endoscopic


Small children

Simptomatic older children & adult


Patient with altered mental status
Patient with intentional ingestion
Patient with potential for significant
injury
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Medical therapy in caustic ingestion

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Management of caustic injury

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2yr old boy with focal esophageal stricture


after
glacial acetic acid of ingestion

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Poison control centre in Indonesia

Bandung
Poison Information Health Service - West Java
Jl Pasteur No. 25
Bandung
Director: Dra Hj Sri Sulastri
Telephone: +62 (0)22 421 2800
Jakarta
National Poisons Information Centre (NPIC)
Sentra Informasi Keracunan, Badan POM/
Bidang Informasi Keracunan, Pusat Informasi Obat dan Makanan, Badan POM.
Jl. Percetakan Negara No. 23
Jakarta 10560
Head: Dra Daya Sundari S
Telephone: +62 21 425 9945
Emergency telephone: +62 813 1082 6879
Fax: +62 21 4288 9117
E-mail: pusatiomker@cbn.net.id or informasi@pom.go.id
Surabaya
Poison Information Health Service - East Java
Jl Ahamad Yani No. 118
Surabaya
Director: Dra Lilik Suharti
Telephone: +62 (0)31 828 0660
Fax: +62 (0)31 828 0660

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Gastrostomy

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Gastrostomy

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