Caustic Agents Research Articles

Risk factors for symptomatic esophageal stricture after caustic ingestion-a retrospective cohort study.

Esophageal stricture is a major secondary complication of ingesting caustic agents. We examined our experiences with caustic injuries with a view to finding clinical and biological risk factors of esophageal strictures secondary to caustic ingestion. Records were retrieved for 58 adults admitted consecutively to our intensive care unit for caustic ingestion. Fifty cases were managed conservatively and therefore retained for analyses. Patients were grouped according to whether they developed strictures or not during the follow-up period. Mucosal damage was assessed by emergency endoscopy. Eleven patients (22%) developed a stricture. At referral, dysphagia, epigastric pain, and hematemesis were associated with secondary stricture (respectively P = 0.047, P = 0.008, P = 0.02). A high Zargar endoscopic grade (above IIa; P = 0.02), the ingestion of strong acids or alkalis (P = 0.006), hyperleukocytosis (P = 0.02), and a low prothrombin ratio (P = 0.002) were associated with a higher risk of developing a stricture. The median delay of stricture diagnosis was 12 (8;16) days after ingestion, with extreme values from 4 to 26 days. Initial symptoms such as dysphagia or hematemesis, early endoscopy showing >IIa grade esophagitis, and certain laboratory results should draw the physician's attention to a high risk of esophageal stricture.

Clinical and endoscopic findings of children hospitalized in Qa'em Hospital of Mashhad due to caustic ingestion (2011-2013).

IntroductionOne of the leading causes of damage to the gastrointestinal tract in children is caustic ingestion which is sometimes life-threatening. The most reliable way to study the severity and extent of damage is endoscopy, which can be harmless in terms of time and technique. The aim of this study was to investigate, evaluate and compare clinical findings and endoscopic results of caustic ingestion.MethodsThis retrospective cross-sectional study was conducted on the records of children diagnosed with caustic ingestion, and hospitalized in Qa’em Hospital of Mashhad from March 2011 to December 2013. Intended data were extracted from patients’ records and in case of any ambiguity, it was removed by phone call. Obtained data were analyzed using SPSS 11.5 and chi-square test.ResultsOf 54 patients, there were 36 cases of burn with acidic substance and 16 cases of burn with alkaline. The highest value was related to caustics related to acid batteries (31.5%) and in 77.5% of cases the container of caustic agent was not standard. In endoscopic results, 50 patients out of 54, had esophagus burn such that in 6 cases it was grade I burn, in 15 cases grade IIa, 27 cases with grade IIb and 2 cases with Grade IIIa burn. In addition, mild erythema of stomach in 6 cases, average erythema in 5 cases, mild ulcer in 15 cases, average ulcer in 5 cases and 3 cases with severe ulcer were reported. There was no significant relation between clinical findings and endoscopic results (p=0.68).ConclusionSince caustic ingestion can be regarded as a life-threatening factor for children, the importance of observing precautions in the storage of caustics and the role of training and adequate attention of parents to this issue to prevent such accidents is clear.

A Unique Case of Accidental Ingestion of Potassium Permanganate

Potassium permanganate is a caustic agent used commonly for antiseptic purposes. When taken orally, in accidental and suicidal cases, it is known to induce local injury to the aerodigestive tract as well as other systemic conditions. A summary of symptoms as well as recommended treatment for potassium permanganate ingestion is discussed here. We present a case of a 75-year-old female who kept potassium permanganate for treatment of equine wounds on her farm. She stored it in her medicine cabinet, later mistaking it for her own medication. Improper storage of medication, in this case, led to a situation that could have become life-threatening. Causes and prevention of unintentional poisoning of the elderly are discussed.

Epidemiologic Features and Outcomes of Caustic Ingestions; a 10-Year Cross-Sectional Study.

Caustic ingestions are among the most prevalent causes of toxic exposure. The present 10-year survey aimed to evaluate the epidemiologic features and outcomes of caustic ingestion cases presenting to emergency department. This is a retrospective cross-sectional study on patients who were admitted to a referral toxicology center during 2004 to 2014, following caustic ingestion. Baseline characteristics, presenting chief complaint, severity of mucosal injury, complications, imaging and laboratory findings as well as outcomes (need for ICU admission, need for surgery, mortality) were recorded, reviewing patients' medical profile, and analyzed using SPSS 22. 348 patients with mean age of 37.76 ± 17.62 years were studied (55.6% male). The mean amount of ingested caustic agent was 106.69 ± 100.24 mL (59.2 % intentional). Intentional ingestions (p < 0.0001), acidic substance (p = 0.054), and higher volume of ingestion (p = 0.021) were significantly associated with higher severity of mucosal damage. 28 (8%) cases had died, 53 (15.2%) were admitted to ICU, and 115 (33%) cases underwent surgery. It seems that, suicidal intention, higher grade of mucosal injury, higher volume of ingestion, lower level of consciousness, lower serum pH, and higher respiratory rate are among the most important predictors of need for ICU admission, need for surgery, and mortality.

Use of skin-lightening products among selected urban communities in Accra, Ghana.

The practice of skin lightening has been reported from North America, Europe, Asia, and Africa. In literature, some prevalence rates exceed 50%, and both sexes are involved. Common agents used include hydroquinone, mercury, corticosteroids, and caustic agents. The agents are easily accessible and affordable with very little regulation. Cutaneous and systemic side effects occur but do not appear to be a deterrent, as the notion of light skin as a surrogate for beauty is strong. In Ghana, anecdotal reports of high bleaching rates among certain urban communities resulted in a study supported by the Food and Drugs Authority to determine various facets of this practice. A cross-sectional study among adults in selected urban fishing communities of Accra was undertaken. Consecutive cases were enrolled after written informed consent. A questionnaire was administered, followed by physical examination and clinical photographs. Descriptive statistics were used to analyze the data. Of the 555 participants from the three communities, prevalence was 279 (50.3%). Duration of use ranged from 2months to 17years. Approximately 212 (76%) used more than one product, and 231 (82%) used agents on their face and body. Dermatological features were hypopigmentation 270 (96.8%), other color changes including ochronosis 241(86.4%), changes in consistency 141 (50.3%), striae 157 (56.3%), and infections 42(15.1%). The prevalence of skin bleaching was 50.3% in these communities, which is high considering the adverse effects from the practice. We recommend regulation of products by enforcing the law, more education, and a population prevalence study.

Eficacia de las técnicas quirúrgicas más utilizadas en el tratamiento de la onicocriptosis: una revisión sistemática

BackgroundThe onychocryptosis, commonly known as ingrown toenail, is a condition of the nail apparatus in which damages the nail fold. This causes pain and inflammation and has serious alterations person's quality of life, causing inability to perform daily activities. So, is very important to choose a good treatment. Material and methodsA literature review was conducted to assess which surgical technique for the treatment of onychocryptosis was the most frequently used in the period (2007-2014), and which has lower rate of relapse and / or recurrence presented. The selection resulted in 13 articles evaluating chemical matrixectomies techniques and wedge resection technique, Suppan I or similar. ResultsThe chemical matrixectomies was the most employed techniques to treat ingrown toenails, mainly employing phenol as caustic agent. In the same way, had significantly lower rates of relapse and / or recurrence (2.02%) than wedge resection techniques or Suppan technique ConclusionsChemical matrixectomies are currently the most widely used surgical techniques, which provide good results and low recurrence rates presented, so are considered the most effective technique for the treatment of onychocryptosis.

Occupational-related chemical ocular injuries: an analysis of 82 patients

Objectives. To investigate the characteristics of occupational chemical eye injuries. Methods . Medical records of patients, who were registered to hospital officially as occupational chemical eye injuries between January 2010 and December 2013, were reviewed. The age, gender, injured eye, chemical agent, nature of the chemical, ocular findings, emerging complications and the information whether the patients knew the chemical agent causing the injury was recorded. Results. One hundred one eyes of 82 patients (2 women, 80 men) were included in the study. The mean age of the patients was 32.9±8.6 years (range: 19-59 years). Injury was bilateral in 19 patients. Chemical agents were not known by 53% of the patients. The most known agents were caustic agents (23%). Sulfuric acid (9%) and calcium hydroxide (4%) were other known chemical agents. The most common injury was superficial punctate epitheliopathy. Ten eyes of 9 patients had corneal edema. This injury was caused by acidic agents in 5 and alkaline agents in 3 patients. Corneoscleral perforation accompanied by chemical injury in one patient with car battery explosion. Conclusions . Most of the workers, who had eye injuries with chemicals, do not know the nature of chemical agent which caused the injury. Ocular morbidities may be decreased with the education of the workers about chemicals, working environment and protective measures.

Whether or not to perform an early endoscopy following ingestion of potentially caustic agents - a retrospective longterm analysis in a tertiary referral institution

The optimal clinical management of patients following ingestion of potentially caustic lesions is still undetermined. In particular, the indication for early upper GI endoscopy in this context remains unclear. To draft recommendations regarding the use of early upper GI endoscopy following hospital admissions of patients after ingestion of potentially caustic agents. For this purpose, a retrospective cohort study of patients treated for ingestion of potentially caustic substances during a 13 year-period at the university hospital of Berne was performed. In total, 61 patients with acute ingestion of potentially caustic substances were identified. Overall mortality was 5 %. 11/61 patients had to be admitted to the intensive care unit. Most ingestions were performed in suicidal intention (62 %). In 53 % of these patients, a combined ingestion of several substances occurred. In 33 % of patients, an early upper GI endoscopy was performed within 24 hours after ingestion. The degree of burn depended upon the hazard potential of the respective substance. In patients with ingestion of low risk substances, upper GI endoscopy was only performed when additional risk factors were present. Based upon the results of the present study, ingestion of potentially caustic agents requires an individualized strategy whether or not to perform early endoscopy.

Transcatheter Myocardial Needle Chemoablation During Real-Time Magnetic Resonance Imaging: A New Approach to Ablation Therapy for Rhythm Disorders.

Radiofrequency ablation for ventricular arrhythmias is limited by inability to visualize tissue destruction, by reversible conduction block resulting from edema surrounding lesions, and by insufficient lesion depth. We hypothesized that transcatheter needle injection of caustic agents doped with gadolinium contrast under real-time magnetic resonance imaging (MRI) could achieve deep, targeted, and irreversible myocardial ablation, which would be immediately visible. Under real-time MRI guidance, ethanol or acetic acid was injected into the myocardium of 8 swine using MRI-conspicuous needle catheters. Chemoablation lesions had identical geometry by in vivo and ex vivo MRI and histopathology, both immediately and after 12 (7-17) days. Ethanol caused stellate lesions with patchy areas of normal myocardium, whereas acetic acid caused homogeneous circumscribed lesions of irreversible necrosis. Ischemic cardiomyopathy was created in 10 additional swine by subselective transcoronary ethanol administration into noncontiguous territories. After 12 (8-15) days, real-time MRI-guided chemoablation-with 2 to 5 injections to create a linear lesion-successfully eliminated the isthmus and local abnormal voltage activities. Real-time MRI-guided chemoablation with acetic acid enabled the intended arrhythmic substrate, whether deep or superficial, to be visualized immediately and ablated irreversibly. In an animal model of ischemic cardiomyopathy, obliteration of a conductive isthmus both anatomically and functionally and abolition of local abnormal voltage activities in areas of heterogeneous scar were feasible. This represents the first report of MRI-guided myocardial chemoablation, an approach that could improve the efficacy of arrhythmic substrate ablation in the thick ventricular myocardium.

Caustics

A caustic is any substance capable of causing full-thickness damage on contact with healthy, intact tissue. Caustic agents are generally classified by pH as acids or bases. Irritants are those substances that do not produce true breakdown of tissue but cause discomfort and inflammation, such as vomiting, burning eyes, or coughing. This review covers caustic and irritant agents, dermal caustic exposure, caustic inhalation and pulmonary irritants, caustic ingestion, and ocular caustic exposure, along with special consideration of hydrofluoric acid, including hydrofluoric acid and dermal exposure, hydrofluoric acid ingestion, hydrofluoric acid inhalation, ocular hydrofluoric acid exposure, and systematic hydrofluoric acid toxicity. Figures show classification of burns; chemical burns; an autopsy specimen of the tongue, epiglottis, and esophagus after caustic ingestion; and an autopsy specimen of the stomach after caustic ingestion. Tables list common caustic and irritant agents, household products containing caustic and irritant agents, agents for which water or saline irrigation is not recommended, indications for endoscopy after caustic ingestion, ocular chemical burn management, and common chemicals and products containing fluoride. Key words: caustic eye injury, caustic ingestion, caustic injury, chemical burn, hydrofluoric acid, pulmonary irritants This review contains 5 highly rendered figures, 6 tables, and 53 references.

Caustics

A caustic is any substance capable of causing full-thickness damage on contact with healthy, intact tissue. Caustic agents are generally classified by pH as acids or bases. Irritants are those substances that do not produce true breakdown of tissue but cause discomfort and inflammation, such as vomiting, burning eyes, or coughing. This review covers caustic and irritant agents, dermal caustic exposure, caustic inhalation and pulmonary irritants, caustic ingestion, and ocular caustic exposure, along with special consideration of hydrofluoric acid, including hydrofluoric acid and dermal exposure, hydrofluoric acid ingestion, hydrofluoric acid inhalation, ocular hydrofluoric acid exposure, and systematic hydrofluoric acid toxicity. Figures show classification of burns; chemical burns; an autopsy specimen of the tongue, epiglottis, and esophagus after caustic ingestion; and an autopsy specimen of the stomach after caustic ingestion. Tables list common caustic and irritant agents, household products containing caustic and irritant agents, agents for which water or saline irrigation is not recommended, indications for endoscopy after caustic ingestion, ocular chemical burn management, and common chemicals and products containing fluoride. Key words: caustic eye injury, caustic ingestion, caustic injury, chemical burn, hydrofluoric acid, pulmonary irritants This review contains 5 highly rendered figures, 6 tables, and 53 references.

The Damage Pattern to the Gastrointestinal Tract Depends on the Nature of the Ingested Caustic Agent.

The mechanisms of damage to the gastrointestinal tract after caustic ingestion are conditioned by the nature of the ingested agent. Whether the nature of the ingested agent has a direct influence on patient outcomes is unknown. From January 2013 to April 2015, 144 patients underwent emergency management for caustic injuries at the Saint Louis Hospital in Paris. There were 51 men (51%) and the median age was 44years [39, 48]. The ingested agents were soda-based strong alkali in 85 patients (59%), strong acids in 36 patients (25%), and bleach in 23 patients (16%). Emergency and long-term outcomes were compared according to the nature of the ingested agent. Four patients died (3%) and 40 patients (28%) experienced complications. After bleach ingestion, emergency morbidity and mortality were nil, no patient required esophageal reconstruction, and functional outcome was successful in all patients. Acids were more likely to induce transmural gastric (31 vs. 13%, p=0.042) and duodenal (9 vs. 0%, p=0.04) necrosis than strong alkalis, but rates of transmural esophageal necrosis were similar (14 vs. 12%, p=0.98). No significant differences were recorded between emergency mortality (9 vs. 1%, p=0.15), morbidity (33 vs. 33%, p=0.92), the need for esophageal reconstruction (25 vs. 20%, p=0.88), and functional success rates (76 vs. 84%, p=0.31) after acid and alkali ingestion, respectively. Bleach causes mild gastrointestinal injuries, while the ingestion of strong acids and alkalis may result in severe complications and death. Acids cause more severe damage to the stomach but similar damage to the esophagus when compared to alkalis.

Esofagitis eosinofílica. Esofagitis infecciosa. Esofagitis tóxicas. Esofagitis cáusticas

IntroductionThe esophagitis is a group of entities that have in common the injury, inflammation and irritation of the esophageal mucosa. AetiopathogenesisThis group of diseases can be caused by multiple causes such as drugs, infectious, caustic agents or even be part of an immunoallergic pathology as eosinophilic esophagitis. Clinical manifestationsDysphagia, sore throat, chest pain or food impaction are different ways of expressing this type of pathology. DiagnosisIt is based on clinical suspicion and mainly performing endoscopy. TreatmentThe common element is the inhibition of the production of acid and specifically, topical steroids, antifungals or appropriate supportive measures secure complications.This update will cover the most common types of esophagitis, encompassing clinical, diagnosis and subsequent management and treatment.

Chéilites : orientation diagnostique et traitement

The whole examination of oral cavity, other mucosae and skin is required when managing a cheilitis. Irritants (climatic, mechanical, caustic agents...) constitute the main aetiological factors of cheilitis. Allergic contact cheilitis should be investigated with a detailed anamnesis in order to search any causative agent in contact with the oral mucosae. Patch testing is required to confirm the diagnosis of delayed hypersensivity. Chronic actinic cheilitis occurs mostly in middle-aged, fair-skinned men. It is a potentially malignant condition that requires biopsies to exclude severe dysplasia or carcinoma. Angular cheilitis can occur spontaneously but is frequently related with several precipitating factors, such as systemic immune suppression, local irritation and moisture, fungal and/or bacterial infection. Cheilitis can also be seen in various systemic conditions such as lichen planus, lupus, atopic dermatitis and nutritional deficiencies. Erosive and crusty cheilitis and bullous erosive stomatitis are the main oral features of erythema multiforme and Stevens-Johnson syndrome. Granulomatous macrocheilitis (cheilitis granulomatosa) presents with intermittent or permanent lip swelling. It should be confirmed by a biopsy. It can be either isolated (Miescher macrocheilitis) or associated with various systemic conditions.

Granular myringitis: current status of management

&lt;p class="abstract"&gt;&lt;span lang="EN-US"&gt;The Granular Myringitis (GM) is not uncommon though in medical literature it has been reported among the rarer conditions. The aim of this article is to review the clinical features and management of Granular Myringitis (GM). GM is characterized by granulation tissue on the outer surface of the Tympanic Membrane (TM) with or without the involvement of deep bony External Auditory Canal (EAC). The granulations are either localized or diffuse. The granulations over tympanic membrane continue to grow slowly for years. The ensuing fibrosis in patients with granulations of deep bony meatal wall can result into an atresia of the deep bony EAC. The presenting symptom of GM is an ear discharge which may be foul-smelling. However many patients have a sensation of fullness, irritation, mild pain or itching in the ear. If perforation occurs the underlay perichondrium or temporalis fascia grafting is done. In some of the refractory cases granulations are removed and the raw area is covered with skin. Many patients respond well to meticulous microscopic aural toilet and topical antibiotic and steroid ear drops. If patients do not respond then application of topical caustic agents are employed.&lt;/span&gt;&lt;/p&gt;

Esophagitis Dissecans Superficialis: An Uncommon Endoscopic Diagnosis

A 72 year old female with a history of cervical nerve impingement presented with sudden onset of odynophagia. On presentation to the emergency room, the patient reported 6 hours of severe odynophagia which was dull at rest but spastic with swallowing. Of note, the patient had recently started taking cyclobenzaprine at bedtime and had completed a course of prednisone three weeks prior for neck pain attributed to her cervical nerve impingement. She denied fevers, chills, nausea, vomiting, regurgitation, dyspepsia and abdominal pain. She had no prior surgeries. Physical exam revealed an afebrile woman in no apparent distress with normal oropharyx, pulmonary and abdominal exam. Initial laboratory studies revealed CBC and CMP within normal limits. Plain films of the neck revealed no radiopaque foreign bodies or soft tissue swelling. EGD showed long strands of friable tissue paper-like mucosa overlying normal appearing esophageal mucosa. There were no signs of esophageal narrowing or retained food. Biopsies showed diffuse superficial necrosis of the squamous mucosa with separation of the necrotic upper portion from the unremarkable viable deeper layers. Additionally, few intraepithelial eosinophils were noted. These findings were most consistent with esophagitis dissecans superficialis(EDS). The patient completed a month course of twice daily proton pump inhibitor with complete resolution of her symptoms. EDS is a desquamative disorder of the esophagus with a benign natural history that is under-recognized with less than 100 published cases. Currently the etiology of EDS is poorly understood and it has a wide range of associations. The most common pathogenesis is thought to besecondary to injury of the esophageal mucosa, specifically from medications and other caustic agents. Case reports previously had focused on the histological constellation of parakeratosis, strips of epithelium with distinct necrotic edge, and lack of inflammatory infiltrates. More recent studies have proposed a clinicopathologic diagnosis of EDS with the major diagnostic criteria being 3 key endoscopic findings of the esophageal mucosa: (1)strips of sloughed esophagus, (2)normal underlying mucosa, (3)lack of ulceration/friability of adjacent esophageal mucosa. Increased awareness of the clinical, endoscopic, and histologic features of EDS should result in greater detection rates, which will prevent unnecessary investigation and therapies while aiding in the understanding of its etiology.Figure 1Figure 2

Chemical Burn Injury in Kumasi: The Trend and Complications following and Their Management.

Background:A chemical burn refers to irritation and destruction of human tissue caused by exposure to a chemical, usually by direct contact with the chemical or its fumes. The study investigated the trend and complications following chemical burns and their management.Methods:The study involved a retrospective review of Burns Registry at the Burns Intensive Care Unit of the Komfo Anokye Teaching Hospital on patients who were admitted for burns from May 1, 2009 to April 30, 2013.Results:Chemical burns admissions accounted for 3.5% (n = 17) out of the total 487 burns cases, consisting of 12 males (70.6%) and 5 females (29.4%). Mean total burns surface area was 21.9%; mean length of stay in Burns Intensive Care Unit was 9.5 days. The etiological agents for the chemical burns included the following: hot caustic soda 1 (5.9%); acid 9 (53.9%)—the most common; hot ethanol 3 (17.6%); and other chemicals such as other bases, oxidizers, solvents, etc. accounted for 4 (23.5%) etiological agents. Outcome included 11 discharges (64.7%), 6 transferred out to other wards (35.3%), and 0 deaths (0.0%). The complications included severe scar contractures in 5 patients (29.4%), loss of vision: partial/total = 2 (11.8%), gross keloidal/hypertrophic scars = 10 (58.8%).Conclusions:Chemical burns are severe and often cause severe debilitating sequelae including partial/total loss of vision. But the current study showed that only a small population (3.5%) were affected by chemical burns and no death was recorded; society has to be continually conscious of chemicals, especially caustic agents, and hence take the necessary precautions so as to prevent these avoidable complications.

Foregut caustic injuries: results of the world society of emergency surgery consensus conference.

IntroductionLesions of the upper digestive tract due to ingestion of caustic agents still represent a major medical and surgical emergency worldwide. The work-up of these patients is poorly defined and no clear therapeutic guidelines are available.Purpose of the studyThe aim of this study was to provide an evidence-based international consensus on primary and secondary prevention, diagnosis, staging, and treatment of this life-threatening and potentially disabling condition.MethodsAn extensive literature search was performed by an international panel of experts under the auspices of the World Society of Emergency Surgery (WSES). The level of evidence of the screened publications was graded using the Oxford 2011 criteria. The level of evidence of the literature and the main topics regarding foregut caustic injuries were discussed during a dedicated meeting in Milan, Italy (April 2015), and during the 3rd Annual Congress of the World Society of Emergency Surgery in Jerusalem, Israel (July 2015).ResultsOne-hundred-forty-seven full papers which addressed the relevant clinical questions of the research were admitted to the consensus conference. There was an unanimous consensus on the fact that the current literature on foregut caustic injuries lacks homogeneous classification systems and prospective methodology. Moreover, the non-standardized definition of technical and clinical success precludes any accurate comparison of therapeutic modalities. Key recommendations and algorithms based on expert opinions, retrospective studies and literature reviews were proposed and approved during the final consensus conference. The clinical practice guidelines resulting from the consensus conference were approved by the WSES council.ConclusionsThe recommendations emerging from this consensus conference, although based on a low level of evidence, have important clinical implications. A world registry of foregut caustic injuries could be useful to collect a homogeneous data-base for prospective clinical studies that may help improving the current clinical practice guidelines.

Effective Approach to Potassium Permanganate Poisoning: Case Report and Review of Literature

Background: Potassium permanganate (PP) is a highly corrosive and deadly agent with a reported lethal dose of 10 g in adults. In this report, successful treatment of a patient poisoned with three times the lethal dose of PP is presented, and effective and early approach to such emergency toxicologic condition is discussed. Case Presentation:A 24-year-old woman presented to emergency room of our hospital following PP ingestion (30 g) one hour earlier. She had swollen and stained (dark brown / black) oral cavity, tongue, face, neck and palms. As the patient had stridor, labored respiration, and obstructive swollen upper airways in the emergency room; surgical bedside tracheotomy was performed and later she was transferred to intensive care unit for further treatments. Later, a 20-hour regimen of intravenous N-acetyl cysteine injection was started for her. The patient was also treated with proton pump inhibitor, broad spectrum antibiotics, steroid, analgesic and IV fluids. She was decannulated on the 7th day and discharged home on the 13th day post-admission. Discussion: No specific antidote is available for this poisoning and so the mainstay of treatment is supportive. Airway management is of utmost importance since PP exposure can cause upper airway edema leading to respiratory compromise. Intensivists should be prepared for difficult intubation, emergency cricothyrodotomy or surgical tracheostomy to secure airway. Steroids might be useful for reversing airway Conclusion: This case report mainly emphasizes the significance of early management of difficult airway during resuscitation of patients with ingestion of highly caustic agents, namely PP in this report, and timely supportive care for the improved ultimate outcome.

Aluminum Chloride

By definition, a drug is a medicine or substance that exerts a physiologic affect on an organism. In dermatology, medications and substances are utilized on a daily basis from topical treatments to anesthetics in micrographic surgery. The purpose of this column is to focus on some of the more common drugs used in dermatology, specifically their mechanism of action and routine alternatives (if available). This brief focuses on the utilization of aluminum chloride in dermatologic hemostasis and provides a table of alternative caustic agents used for hemostasis.