Ingestion Of Hydrochloric Acid Research Articles

Gastrointestinal mucosal damages caused by ingestion of corrosive substances: A case study of hydrochloric acid and sodium hydroxide.

Ingestion of corrosive substances is most common in children, while in adults causes more severe damages. Massive ingestion of corrosive substances results in severe damage to the gastrointestinal tract and oropharynx if not treated properly. Corrosive substances with pH<2 or >12 can result in severe esophageal damage with either colliquative (alkaline) or coagulative (acidic) necrosis and, at the same time various gastrointestinal injuries could lead to late post-corrosive complications. The aim of the case study was to report the gastrointestinal mucosal damages due to hydrochloric acid (HCl) and sodium hydroxide (NaOH) ingestion. A 55-year-old male patient was presented to the emergency room with a chief complaint of vomiting an hour before admission. Continuous vomiting with a volume of approximately 10-20 cc per vomit. The vomit was initially bluish and turned in to blackish brown over time. Other complaints included nausea, rapid breathing, heartburn, and burning mouth and throat, and had weakness and dizziness. The patient accidentally drank floor cleaning liquid containing HCl. The patient was diagnosed with hematemesis due to ulceration of esophageal, gastric, and duodenal mucosa induced by HCl. Tracheoesophageal fistula developed later in the patient as a long-term complication. Another a 22-year-old male patient was presented to the emergency room with chief complaints of nausea and vomiting an hour before admission. Headache and slight tightness were also experienced. The patient mouth felt burned pain in the solar plexus and frothy saliva. An hour earlier, the patient attempted suicide by drinking two bottles of floor cleaning liquid due to economic problems. The patient was diagnosed with erosive mucosal esophagogastroduodenum induced by NaOH. These cases highlight that intoxication with corrosive substances can complicate damage to the gastrointestinal mucosal and damage features depend on the type of substance concentration and quantity of the corrosive substance.

Man Presenting After Hydrochloric Acid Ingestion.

We describe a case of a man who developed severe caustic injury of his upper gastrointestinal tract after ingestion of a commercially available 9.5% hydrochloric acidic cleaning solution. He rapidly deteriorated and required endotracheal intubation. He underwent several imaging modalities demonstrating his injuries and ultimately succumbed to his injuries. Acidic caustic ingestions may range in severity and uncommonly result in death. Diagnosis is most often achieved by esophagogastroduodenoscopy, although computed tomography may increasingly play a role in defining the extent of injury. Esophagogastroduodenoscopy findings are often assigned a Zargar grade, which guides management. Medical management of acidic caustic ingestion may include bowel rest, steroids, antibiotics, and proton pump inhibitors depending on the extent of injury, although surgery may be required if esophageal perforation occurs.

Chemical Burn-Induced Corrosive Epiglottitis in an Elderly Patient with Major Depression

Acute epiglottitis (AE) is a potential emergency of the respiratory tract caused mainly by bacterial infection. However, nonbacterial infection causes, such as corrosive injuries, may result in death due to gastrointestinal perforation if a timely diagnosis is not available. We report the case of an elderly patient with an acute melancholic episode who encountered corrosive epiglottitis (CE) caused by accidental ingestion of hydrochloric acid and compare the features of CE and AE, including the immediate onset of symptoms, normal findings on blood tests, and endoscopy revealing pale swollen epiglottitis. This case can prove to be an important reference for clinicians for differential diagnosis, especially when treating epiglottitis in patients with psychiatric disorders and unclear expression.

Ingestion of hydrochloric acid in adults

Corrosive ingestion is more commun in the pediatric population(mostly accidents), but adults are also concerned(suicide) with more severe lesions. Massive ingestion of corrosive agents results in severe upper gastrointestinal and oropharyngeal tract injuries requiring multidisciplinary management. The endoscopy is systematic,the gastro-intestinal endoscopy must be conducted under sedation, with minimal insufflation, between 6 to 24 hours after ingestion. Endoscopic injuries must be described according to the Zargar or the Di-Costanzo classification. We report a case describing an ingestion of a strong acid. A 52-year-old woman, with no medical history specially psychiatric illness, was admitted to the emergency room for the voluntary ingestion of half a glass of hydrochloric acid for autolytic purposes after family problems. The patient was admitted to intensive care, she presented with a cough, hypersiallorhea, with epigastralgia, a thoracoabdominal Computed tomography (CT) was conducted and objected a circumferential parietal thickening of the gastric wall in relation with post caustic ulcerative oedematous lesions. Twelve hours later, the esophagogastroduodenoscopy was performed and found a stage I esophagitis, a stage IIIA gastritis according to Di Costanzo (A,B). The medical treatment intaured: digestive rest, proton pump inhibitor and parenteral nutrition. The first endoscopic check was made after a week and showed an improvement in the endoscopic lesions: normal esophagus, fundic gastritis stage IIB and antral gastritis stage IIA according to the classification of Di-Costanzo. Psychiatric follow-up has been instituted. The evolution was favourable, the third endoscopic control after 2 weeks showed the healing of the lesions: antral gastritis stage IIA(C), Fundic gastritis stage I(D) of Di-Costanzo.

Thoracoscopic vagal-sparing esophagectomy and colonic interposition for caustic stricture.

Minimally invasive esophagectomy is an increasing trend in surgery. Thoracoscopic esophagectomy is applicable and an alternative procedure to conventional esophagectomy in patients especially with end-stage benign diseases like caustic stricture. A 33-year-old female patient was admitted to the department of general surgery with dysphagia. The patient was suffering from caustic stricture due to ingestion of hydrochloric acid. A totally thoracoscopic and laparoscopic vagal-sparing esophagectomy and colonic interposition was performed. As a more physiologic alternative, vagal-sparing esophagectomy is the ideal operation for these patients.

Gastric outlet obstruction as a sequel of hydrochloric acid ingestion

&lt;p class="Abstract"&gt;Corrosive injury of the upper gastro-intestinal tract is a common cause of morbidity and may result in mortality. Gastric outlet obstruction is a common late sequel, which is best confirmed by esophagogastroduodenoscopy. The surgical management for gastric outlet obstruction has been proven to be beneficial in relieving the symptoms and improving the quality of life. We present here a case of gastric outlet obstruction following hydrochloric acid ingestion as an attempt of self-harm and its surgical management. After the desired surgical treatment, the patient improved clinically which was also reflected in the biochemical results. Proper patient evaluation and planning of operation are vital before surgery.&lt;/p&gt;

Caustic Ingestion in the Elderly: Influence of Age on Clinical Outcome.

Caustic poisonings are still associated with many fatalities. Studies focusing on the elderly are rare. The purpose of the present study was to compare the clinical outcomes of caustic ingestion injury in elderly and non-elderly adults with regard to gender, intent of exposure, substance ingested, severity of mucosal injury, complications, and mortality. Caustic substance exposures reported to the National Toxicological Information Centre in Slovakia during 1998–2015 were reviewed retrospectively. The patients were divided into two groups: the non-elderly (<60 years) and elderly adults (≥60 years). The mortality rate in the elderly was significantly higher (elderly 23.0% vs. non-elderly 11.3%; p = 0.041). The risk of fatal outcome in the elderly was increased by acid ingestion (OR = 7.822; p = 0.002), particularly hydrochloric acid (OR = 5.714, p = 0.006). The incidence of respiratory complications was almost two times higher in the elderly was 31.1% vs. 17.4% for the non-elderly (p = 0.037). Respiratory complications significantly correlated with an increased mortality rate (p = 0.001) in the elderly whereas there was no association between GI complications and mortality in the elderly (p = 0.480). Elderly patients with respiratory complications had the poorest clinical outcomes. The highest risk of complications and fatalities was observed in patients after hydrochloric acid ingestion.

Caustic effects of chemicals: risk factors for complications and mortality in acute poisoning

The aim of the study was to investigate the incidence of respiratory and gastrointestinal complications in relation to the type of caustic substance and to identify the risk factors for mortality in patients with acute caustic ingestion. We retrospectively reviewed all caustic substance exposures reported to the National Toxicological Information Centre in Slovakia during the 18-year period (1998–2015). Only patients who underwent an endoscopic evaluation within 24 h with positive findings were included in the study (n = 271). The median age was 37 years (1–87). Accidental exposures prevailed over suicidal intent (202/64). The median length of hospital stay was 6 days (1–45). Acid ingestion was associated with increased risk of respiratory (OR 6.5, p < 0.001) as well as gastrointestinal complications (OR 4.8, p < 0.001). The overall mortality was 8.2%. Twenty six of the patients died after ingestion of strong acids (n = 22), paraquat (n = 3), and glyphosate (n = 1). Grade IIIb of caustic injury (OR = 28.2, p < 0.001), ingestion of hydrochloric acid (OR = 7.3, p = 0.003), and suicidal intent (OR = 11.7, p < 0.001) were independent risk factors for fatal outcome after caustic ingestions. Mortality risk was significantly increased in patients ≥55 years (OR = 4.5, p < 0.001). The results of current analysis of the caustic exposures in Slovakia indicate that ingestion of strong acid, particularly hydrochloric acid, suicidal intent, grade IIIb of caustic injury, and age over 55 years are the most important risk factors for fatal outcome as well as predictors for systemic complications.

Interest of Corticosteroid Injection in Refractory Benign Stenosis of the Esophagus

The post-surgical anastomotic oesophageal stenosis is usually benign, which may recur rapidly after several endoscopic dilations (refractory stenosis). The purpose of this work is to show, through an observation, the interest of the injection of the corticoids during the endoscopic treatment of refractory oesophageal stenosis. It was a patient who benefited from an esophagectomy of 2/3 inferior+oeso-gastric anastomosis after ingestion of hydrochloric acid (spirit of salt). The evolution was marked by the installation of a post-anastomotic stenosis recurring after several sessions of endoscopic dilations. The local injection of the corticosteroids (Triamcinolone) at the time of the dilation sessions, allowed a decrease in the frequency of the dilatations, a disappearance of the dysphagia, an improvement of the general state with a weight gain. The injection of corticosteroids was a good solution for this patient, to avoid endoscopic treatment failures, and to improve her quality of life.

Suicide by Ingestion of Hydrochloric Acid: A Case Report

Suicide by Ingestion of Hydrochloric Acid: A Case Report

ST-segment elevation mimicking myocardial infarction after hydrochloric acid ingestion: Acute caustic myocarditis

ST-segment elevation after hydrochloric acid ingestion has barely been described in the literature, without identification of its causal mechanism. We hypothesize that acute caustic myocarditis, by direct contact between necrotic upper gastrointestinal tract and pericardium may induce the ECG findings.

White Esophageal Mucosa and Black Gastric Mucosa: Upper Gastrointestinal Injury Due to Hydrochloric Acid Ingestion

Caustic ingestion can cause severe injury to the esophagus and stomach. The severity and extent of esophageal and gastric damage resulting from caustic ingestion depend upon several factors. In the present report, we describe the case of a 55-year-old schizophrenic man who drank 400 mL of hydrochloric acid. Endoscopy indicated the presence of white esophageal mucosa and black gastric mucosa, which is evident in the images taken before and after ingestion (Fig. 1). Fig. 1 Endoscopic findings. (A) Initial esophagoscopy. No abnormality is noted during the initial examination of the esophageal mucosa. (B) Initial gastroscopy. No abnormality is seen during the initial examination of the gastric mucosa, except for linear erythema. ... Acid ingestion typically produces a superficial coagulation necrosis that results in thrombosis of underlying mucosal blood vessels and consolidation of connective tissue, thereby forming a protective eschar.1 Because acid solutions cause pain upon contact with the oropharynx, the amount of acid ingested tends to be limited. However, in the present case, the patient had schizophrenia, and despite experiencing pain, he drank 400 mL of hydrochloric acid. We believe that the excess hydrochloric acid injured the esophageal mucosa and subsequently turned the esophagus white, due to the development of mucosal edema, exudates, and superficial coagulation necrosis. Typically, when acid is ingested, it flows along the lesser curvature of the stomach towards the pylorus, and pylorospasm impairs emptying into the duodenum, producing stagnation and injury that is particularly prominent in the antrum.2 However, in the present case, excess acid stagnated in the stomach, and as a result, we believe that the gastric mucosa was damaged up to the transmural layer, causing the black coloring of the mucosa. The severity and extent of esophageal and gastric damage resulting from caustic ingestion depend upon three major factors: corrosive properties of the ingested substance; duration of contact with the mucosa; and the amount, concentration, and physical form (solid or liquid) of the agent.3,4 Most ingestions occur in children, whereas the other cases involve psychotic, suicidal, or alcoholic subjects.5 The present case was a subject who was both psychotic and suicidal. Caustic ingestion is usually accidental in children under the age of 5 years and intentional in adults and adolescents. Highly concentrated acids (hydrochloric, sulfuric, and phosphoric acid) present in toilet bowl or swimming pool cleaners, anti-rust compounds, or in battery fluid are less frequently ingested than alkalis.4 When acid remains on the esophagus, burns can occur within 4 hours and perforation can occur within 6 hours; in such cases, urgent endoscopy is indicated. In the present case, we performed esophagogastroduodenoscopy (EGD) within 4 hours of ingestion. Alkali ingestions typically damage the esophagus to a greater extent than the stomach or duodenum, whereas acids cause more severe gastric injury. A study comparing outcomes of acid or alkali ingestion found that the outcomes were worse overall for those who ingested acid.6 Such patients had significantly more severe mucosal injury, were more likely to be hospitalized in the intensive care unit, were more likely to have systemic complications or perforation, and had higher mortality. Caustic injuries to the gastrointestinal tract are classified pathologically, similarly to burns of the skin. First degree injury results from superficial mucosal damage and is characterized by the presence of focal or diffuse erythema, edema, and hemorrhage. The mucosal lining subsequently sloughs without scar formation. Second-degree injury is characterized by the presence of mucosal and submucosal damage, ulcerations, exudates, and vesicle formation. Eventually, granulation tissue develops, followed by a fibroblastic reaction that produces a scar and possible stricture. Third degree injury is transmural and is characterized by the presence of deep ulcers along with black discoloration and perforation of the wall. Endoscopy should be performed as soon as possible—ideally within 24 hours—in order to assess the magnitude and extent of injury, according to the grading system. Subsequent management is determined based on the results of endoscopy. Patients suspected of having serious ingestions (based on history, symptoms, or endoscopic findings) should generally be treated in a surgical or medical intensive care unit for the management of acute, life-threatening complications of injury (mediastinitis, peritonitis, respiratory distress, shock, and metabolic disorder) and to decrease the risk of developing late esophageal strictures. Each patient should be evaluated individually since the clinical picture varies widely, and signs and symptoms alone are an unreliable guide to injury.7 In the case of severe caustic damage, endoscopy should be performed within 24 hours. However, endoscopy is not needed for all patients and may be deferred at the physician's discretion. We experienced an interesting case of acid ingestion wherein endoscopy indicated the presence of a white esophagus and black gastric mucosa; we provide a description of this case with images, along with a review of the literature.

Evaluation of caustics and household detergents exposures in an emergency service

The aim of this study was to analyse the caustic and household detergent exposure cases were admitted to the Department of Emergency Medicine at Dokuz Eylul University Hospital (EMDEU) between 1993 and 2008. Age, sex, reason of exposure, clinical signs, rate of endoscopy in oral exposures, treatment attempts, length of hospital stay and outcome were evaluated. A chi-square test was used to analyse statistical differences. Caustic exposures accounted for 8.5% (1160 cases) and 4.1% (1988 cases) of all poisonings in children and adults, respectively. Female/male ratio of caustic exposure poisonings was 0.8. Most of the exposures were unintentional (158, 86.8%). Intentional exposures were common in cases between 19 and 29 years old (χ(2) = 25.685, p < 0.001). The most common caustic substance was alkaline (106, 58.3%) followed by acidic (47, 25.8%) and other household detergents (28, 15.4%). Vomiting (35.7%), nausea (14.8%) and sore throat (13.1%) were the most common clinical signs. The patients who had endoscopy, the most frequent finding was first-degree damage (58.7%). A 48-year-old man died from intentional hydrochloric acid ingestion. Because of the large number of unintentional caustic exposures, parent education is very important to decrease the caustic exposures in children.

Massive Necrosis of the Upper Gastrointestinal Tract with Acute Gastric Perforation and Metabolic Acidosis after Hydrochloric Acid (HCl) Ingestion

Hydrochloric acid (HCl ; pH, 1) is a widespread product in households around the world, used as a toilet cleaner. As an easy available substance it becomes one of the main causes of the corrosive injuries of the gastrointestinal tract. While ingestion of alkali results primarily in esophageal damage, acids tend to spare the esophagus and produce necrosis of the stomach as in thermal burns. The mechanism of damage is also different ; alkalis produce liquefaction necrosis and acids coagulation necrosis. The extent and the severity of corrosive gastric injury is directly related to the concentration and amount of acidic substance as well as the period of time in the stomach, and to the amount of gastric content at the time of ingestion. We are reporting a case of massive necrosis of the upper GI tract with acute gastric perforation and metabolic acidosis due to suicidal acid ingestion.

Massive gastric necrosis from hydrochloric acid ingestion

Severe gastrointestinal-tract injury due to ingestion of caustic substances is not an infrequent problem in the emergency department. We report the case of a 57-year-old male who developed massive hemorrhagic, caustic gastric necrosis due to the ingestion of a non-diluted solution containing hydrochloric acid, which propitiated an urgent surgical procedure. The esophago-gastrectomy specimen showed extensive hemorrhagic gastric necrosis with important damage to the gastric wall in the histopathological evaluation. The ingestion of caustic substances is a medical problem that is still frequent in emergency departments, either by mistake or with suicidal purposes. The extent and the severity of tissue damage vary according to different factors related to substance type, amount and concentration, as well as other personal factors. We report the case of a 57-year-old male who ingested 20 cc of a non-diluted solution containing hydrochloric acid as a suicide attempt three hours before he was admitted to our hospital. After that he had experienced vomiting with emission of black sloughs. He was clinically and hemodynamically stable with only intense epigastric pain. An ORL exploration and chest and abdominal radiographs showed no complication signs. An urgent gastroscopy revealed that the esophageal mucosa was not necrotic but ulcerated in some areas. In the esophago-gastric junction a transition to an ulcerated gastric mucosa could be seen, with severe diffuse hemorrhagic necrosis and sloughs that easily fell off with endoscope maneuvers (Fig. 1) compatible with grade-3 caustic gastritis according to Zargar’s classification (1). The duodenum was not explored because of perforation risks. An urgent surgical intervention was performed due to the high risk of perforation. The esophagus was ulcerated and the stomach had extensive areas of necrosis, so partial esophagectomy and total gastrectomy were performed to avoid the risk of future complications, doing an esophagostomy and terminal ileostomy. The histopathological analysis of the surgery specimen showed extensive hemorrhagic gastric

Fatal myocardial infarction after hydrochloric acid ingestion in a suicide attempt

Ingestion of acid-containing household products either accidentally or for suicide attempt is a common form of intoxication. Hydrochloric acid is widely used as an antirust compound or cleaner in homes and is highly corrosive and generally causes coagulation necrosis which could lead to perforation in the gastrointestinal system. Although hydrochloric acid ingestion is mainly harmful to the gastrointestinal system, it may also cause metabolic acidosis, hemolysis, renal failure, and fatality as well. Cardiovascular manifestations of hydrochloric acid ingestion are extremely rare, and we report a 48-year-old man who died of acute inferolateral myocardial infarction after hydrochloric acid ingestion in a suicide attempt who had no history of coronary artery disease. In conclusion, although cardiovascular manifestations of hydrochloric acid ingestion are extremely rare, the ingestion may still cause myocardial infarction which could be fatal. Physicians dealing with hydrochloric acid ingestion in the ED should be aware of this possibility and always obtain serial electrocardiograms even if the patient has no cardiac complaint.

Laparoscopic transhiatal esophago-gastrectomy after corrosive injury

Esophago-gastric necrosis is a surgical emergency associated with high morbidity and mortality. We report a laparoscopic transhiatal esophago-gastrectomy performed on a 43-year-old male, presenting two hours after hydrochloric acid ingestion. A gastroscopy showed several oral mucosal ulcers, a significant edema of the pharynx and larynx, a necrosis of the middle and lower esophagus and of the gastric fundus and antrum. A conservative strategy with intensive care observation was initially followed. After a change of clinical signs, chest-abdominal computed tomography was realized and a pneumoperitoneum with free fluid in the left subphrenic space and bilateral pleural effusions was in evidence. A laparoscopic exploration was proposed to the patient, and confirmed the presence of free peritoneal fluid and necrosis with perforation of the upper part of the stomach. A laparoscopic total gastrectomy with subtotal esophagectomy was performed; the procedure finished with an esophagostomy on the left side of the neck and a laparoscopic feeding jejunostomy (video). Total operative time was 235 minutes. After six months a digestive reconstruction with esophagocoloplasty by laparotomy and cervicotomy was easily realized thanks to the advantages (few adhesions, bloodless, and simple colic mobilization) of the previous minimally invasive surgery.

Corrosive-induced gastirc outlet obstruction without oesphageal involvement: A case report

The objective of this paper is to report an unusual case of isolated gastric outlet obstruction following corrosive ingestion. A case report of a 28-year old female seen by the authors. The literature on gastric outlet obstruction following ingestion of corrosives is reviewed briefly. Features of worsening gastric outlet obstruction were found in this 28-year old female five months after ingestion of hydrochloric acid. There was an antecedent history of depressive illness. The upper gastrointestinal barium contrast radiographs showed a normal oesophagus and proximal stomach. The distal stomach was however scarred, contracted with severe antropyloric stenosis. She underwent nutritional rehabilitation with high protein diet and made an uneventful recovery after a gastrojejunostomy. This case suggests a relative resistance of the oesophagus to corrosive acids as reported in the literature. The stomach, however, is more susceptible to acids causing burns with subsequent cicatrisation around the antrum and pylorus.

Surgical and endovascular treatment of secondary aortoesophageal fistula

Aortoesophageal fistula is an uncommon and highly fatal condition, even if opportunely treated. In rare cases it has been encountered in association with extensive corrosive injury. No cases of successful endovascular repair of aortoesophageal fistula caused by corrosives are reported in the English-language literature. We report a case of severe esophagogastritis caused by massive ingestion of hydrochloric acid complicated by aortoesophageal fistula. Combined surgical and endovascular treatment by means of a stent graft proved to be successful.

Delayed Gastric Perforation Resulting from Hydrochloric Acid Ingestion

1All authors: Department of Radiology, Harborview Medical Center, University of Washington School of Medicine, 325 Ninth Ave., Box 359728, Seattle, WA 981042499. Address correspondence to F. A. Mann (famann@u.washington.edu). Case Report A 29-year-old man with schizophrenia presented to the emergency department with abdominal pain immediately after ingesting approximately 200 mL of cleaning solution containing 36% hydrochloric acid. Initial unenhanced CT of the chest, abdomen, and pelvis showed an intact stomach and a small amount of free intraperitoneal fluid (Fig. 1A). Direct endoscopy showed mucosal injury in the oropharynx, hypopharynx, and supraglottic region, and diffuse caustic injury to the esophageal mucosa. Because of worsening clinical status, a contrast-enhanced CT of the abdomen was performed 2 days later, showing gastric necrosis and perforation (Fig. 1B). The patient died shortly thereafter.