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CAUSTIC
POISONING INGESTION
YENI H RY NI
PEDIATRIC EMERGENCYSUBDIVISION
LITER TURE REVIEW
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INTRODUCTION
poisoning ingestion is stillmajor problem in society
AAPC, 1998, 1.08 millioningestion substances < 6yr.
common agents :household product,industrial cleaners, beauty product,petroleum, pesticida, opium, plant,herbal, medicine, hydrocarbon.
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Caustic
agents
Alkaline
pH>7
Accepting proton
Acid
pH
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Epidemiology
200.000 cases/yr
Household product
US Poisoncentre
148 children Dec2005-July 2008
Italy
Glacial acetic acidEast Asia
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Insidens
Accidental poisoning
Liquid form
Children
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C U S E S
Alkaline NaOH, KOH : drain
cleaner, oven cleaner,clini tablet, dentalcleaner
CaOH: cement, plester
Na hipochlorite, Cahipochlorite: bleaches,
clor solutionAmonia: 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, glasscleaner
HCl: toilet cleaner,swimpool cleaner,laboratory equipmentcleaner
Acetic acid: decinfectant
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P THOPHYSIOLOGY
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 andcoagulation
abdomen is the most
involved organ 7
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CLINIC L M NIFEST TION
History
Dyspnea, disfagia,odinofagia
Chest pain,abdominal pain,nausea, vomiting
Physicalexamination
Airway obstructionBurns on orofaring
drooling,
Acute peritonitis
haematemesis
Syok, mental abnormal
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W O R K U P
Laboratory:pH of substance ingestion
pH of salivaCBC, electrolyte, BUN,creatinin, BGA
Liver function test, DIC testUrinalysis, urine output
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Radiologyc Examination
chest x-ray :pneumomediastinum, pleuraleffusion, pneumoperitoneum,
foreign bodiesPlain abdomen :
pneumoperitoneum, ascites,foreign bodies, perforation
CT-scan : extralumen air10
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E n d o s c o p y
Timing :1st: 24 hour after ingestion
2nd: 3-4 weeks later
ClassificationIndication
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History
Physical examinationSupportive
examination
Diagnosis
Burn injury
Gastrointestinalbleeding
Differentialdiagnosis
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HOSPIT L M N GEMENT
Airway ControlAirway and mental status
assesmentEndotrachea, cricotiroitomi
intubation
Gastric Emptying &Decontamination
Not recomended: induce vomiting & gastriclavageSuction via NGTActive charcoal: relatif contraindication
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... Hospital Management
dilution
Do not do neutralisir
Intravenous access,blood
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...hospital management
Medication
drugs
Corticosteroid
antibiotic
Antacida,H2Blocker, PPI
Analgesicnarcotic
Indication
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...Hospital management
Gastrostomy Parenteral nutrition: CVPNutrition
4-6 wks after ingestion Pneumatic dilatation,
stenting
EBD,bouginaseesophageal
Topical, Antifibrotic agent
Inhibition of fibroblast,decreasing scarring
Mitomycin C
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MANAGEMENT SUMMARY
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E
R
L
Y
C
O
M
P
L
I
C
T
I
O
N
Airwayobstruction
perforation
Mediastinitispleuritis
Gastrointestinal bleeding
Cardiacarrest
syok
peritonitis 19
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Late
Complication
Esophagealstrictur
Squamouscell
carcinoma
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P R O G N O S I S
Tissue injury
Treatment : basic,symptomatic,supportivetreatment
Anticipatecomplication
Stricturesophagal:
Squamous cellcarcinoma
Death
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CONSULT TION
Surgery: perforation, peritonitis
Endoscopy : indication
Poison Control Centre
Psikiatri : suicide attempt
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PREVENTION
Parents :
Caustic agentsstore in child
resistant containers
Industrialcorporation:
Reduced
concentration ofhousehold product
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CONTROVERSION
SteroidAntibiotic
Endoscopy
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MANAGEMENT PATHWAY
Suspected poisoningAnd treatment
Poison Control Centre
Indonesia
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SUMM RY
Caustic Poisoning Ingestion may
cause devastating injury inchildren. Stepwise care approachinclude: diagnosis, treatment, and
anticipate complication are helpfulin successful management.
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TH NK YOU
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Endoscopic view of the
esophagus in a patient whoingested hydrochloric acid
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Zargar Endoscopic Classification Scheme for Caustic mucosal
Injury
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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, scatteredareas of necrosis
Grade IIIB: extensive necrosis
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Indication for Endoscopic
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Small children
Simptomatic older children & adult
Patient with altered mental status
Patient with intentional ingestion
Patient with potential for significantinjury
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Medical therapy in caustic ingestion
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Management of caustic injury
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P i t l t i I d i
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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 SulastriTelephone: +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: [email protected] [email protected]
SurabayaPoison 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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