Caustic ingestion: an 11-year retrospective analysis of 190 patients

Objective: caustic gastrointestinal (GI) lesions are one of the most devastating events in acute toxicology, often associated with high mortality risk and permanent sequelae (1). Caustics can be divided in acids and alkalis according to their pH. Objective of this review is to evaluate the different epidemiology, outcome and mortality rate based on different pH of caustic substances. Methods: we observed 190 consecutive cases of caustic ingestion admitted to our unit from 1999 to 2010. Epidemiology, degree of oral and endoscopic GI tract lesions and mortality rate were examined and evaluated both in the total sample and in consideration of the caustic pH (acid or alkali). Results: 190 (100%) consecutive cases were examined; 147 (77,4%) were alkalis ingestions (32 strong alkalis) and 43 (22,6%) were acids ingestions (30 strong acids). Oral injuries were 108 (57%). 129 cases (68%) of total sample underwent endoscopy. Endoscopic GI injuries were present in 95 (74%) cases; 18 (86%) and 77 (71%) in acid and alkalis ingestion, respectively. A correlation between oral and endoscopic GI lesions was analyzed and 26 (63%) patients without oral lesions showed esophageal and/or gastric lesions. Survival rate was 96.3% (183 cases) in total sample while mortality rate was 3.7% (7 cases). 6 of the 7 dead patients had an history of strong acids ingestion. In particular, mortality rate was 20% and 3.2% of strong acids and alkalis ingestion, respectively. Cases discharged with GI sequelae were 4%, all in alkalis ingestion. All deceased patients had an history of self-harm ingestion. Conclusions: volunteer strong acids ingestion showed an higher mortality rate than strong alkalis ingestion. Alkalis ingestion was characterized by GI sequelae. Following the clinical relevance of caustic ingestions, an emergency treatment algorithm in order to better treat caustic ingestion intoxication is needed. References: 1. Bronstein A, et al.; 2009 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS); Clin Toxicol 2010.