Parents accompanying their child, who has ingested a corrosive substance, to the emergency room often have no idea what happened. They do not know that they will face many months of treatment, which sometimes cannot prevent permanent consequences. Recently, at the ENT clinic II.LF in Motola, we have noticed an alarming increase in cases of severe injuries to the swallowing and respiratory tracts of small patients, caused by accidental ingestion of these substances. In almost all cases, the incident did not have to occur if basic safety measures were followed.
Let's talk about the origin, symptoms, first aid, treatment, possible consequences and especially about the prevention of these serious conditions in childhood.
From a medical point of view, caustic means a substance that is capable of causing its destruction in direct contact with living tissue. Chemically, these are compounds of an acidic or basic nature - acids and alkalis, which are components of, for example, various cleaning agents.
After ingestion of a corrosive substance, the mucous membranes of the digestive tract are immediately damaged - starting from the lips and oral cavity to the stomach. The degree of impairment depends on the aggressiveness of the substance - in the case of acids and bases, it is directly proportional to the values of the pH scale.
The mechanism of damage is somewhat different for both types of caustics. When acids come into contact with the mucous membrane, they form so-called scum. The lye penetrates deeper and the affected tissue has a rather jelly-like, soapy appearance. They are more aggressive. Depending on the amount, concentration and composition of the ingested solution, in addition to local changes, general changes - intoxication can also occur.
Parents catch a crying child with a caustic container in his hand, often with a burnt mouth and tongue, and they don't know if he swallowed the substance or not. The first and constant symptom of a digestive tract burn is usually pain. The degree of pain depends on the extent of the injury - from a burning sensation to severe pain.
In small children, however, we cannot distinguish the intensity of the pain. Sometimes a burn can be manifested by bleeding from the oral cavity - disruption of the vessels of the digestive tract. Another symptom is increased salivation - accumulation of saliva during painful swallowing. These symptoms precede general symptoms caused by eventual poisoning / intoxication / and are crucial for recognition and timely intervention.
When it comes to first aid - immediately after ingesting a corrosive substance, let the child drink whatever we have at hand, preferably milk. Dilution or neutralization of the corrosive substance within one minute after ingestion is of greatest importance. We only give neutralizing solutions - e.g. diluted vinegar or soapy water if we have them immediately at hand and we are sure of the composition of the ingested substance, otherwise we could make the condition even worse. Decisive for the success of first aid is timely removal to a specialized workplace. This is how we proceed even if we only suspect the ingestion of a caustic. For example, if we find a crying child with burned lips or oral cavity, or if the child claims to have drunk caustics, but does not show signs of being burned.
The treatment procedure depends primarily on determining the extent of the burn. The oral cavity has good regenerative capabilities and even a relatively severe burn does not leave permanent consequences. The situation is different in the area of the esophagus, which is most exposed to the effect of the caustic. This muscular tube lined with mucous membrane used to transport food to the stomach is relatively resistant to caustics, especially in places of natural narrowing.
Immediately after admission to hospital care, an endoscopic examination of the esophagus (esophagoscopy) is performed under general anesthesia. If there are signs of cauterization in the esophagus, a stomach tube is inserted through the nose. It has the task of bringing food directly into the stomach and preventing food from coming into contact with the affected esophageal mucosa and at the same time limiting the occurrence of narrowing (stenosis) of the esophagus. The treatment is supplemented with corticoid preparations, which have a favorable effect on reparative processes, antibiotics and pain-relieving drugs are administered as a preventive measure. The narrowing that occurs approximately in the third week after the burn as a result of scar healing is a dreaded complication and the most common long-term or permanent consequence of an injury. it causes the bite to stick in the esophagus, it can even lead to complete closure of the esophagus and the inability to swallow even liquid. In the treatment of developed stenoses, repeated dilations (widening) of the narrowed area with special introducers are used. If even this therapy is unsuccessful, complex surgical procedures begin with the aim of replacing the damaged esophagus with other tissues - stomach, intestine. In extreme cases, a permanent gastrostomy is necessary - a gastric outlet. And in the most severe cases, the complications are life-threatening for the patient.
Does such an injury have to happen at all? It is almost always the result of negligence on the part of parents or anyone else. The most vulnerable group are children between 1 and 4 years of age. However, considerably older patients are no exception - most often ingestion of caustic stored in an unmarked lemonade bottle, etc.
An interesting case of mass ingestion of corrosive material happened recently. 13 classmates swallowed balls of concentrated caustic soda. They were ten-year-old pupils of the 3rd grade of a Prague school. During the afternoon stay with the group in the park, their two-years-younger classmate offered them caustic in the form of hot candies and a multivitamin. He found the marbles under the bench in a lentil box wrapped in a red scarf. Fortunately, the incident was without serious consequences. Two boys were found to have slight changes in the esophagus caused by the caustic without the need for further intervention. The burns on the lips, oral cavity and tongue healed completely. The case is being investigated by the police.
The main principles of preventing injuries caused by the ingestion of caustic substances are simple - store all dangerous substances / toilet cleaners, waste, dishwashers, grills, lye granules, preparations for etching joints.../ in a hard-to-reach, preferably very high place out of reach of children. As a matter of principle, do not pour any unknown substances into beverage bottles. This applies especially to the sale of various cleaning solutions poured by street vendors into their own containers. better avoid when buying. It is also important to note whether the caustic bottle has a safety cap that can only be unscrewed after pushing, etc.
Following these rules really pays off.
Michal Jurovčík, M.D ENT clinic II LF UK in Motola Prague 5 150 00 Tel. 24432601 Fax 24432620 e-mail: michal.jurovcik@lfmotol.cuni.cz in Prague 13.5. 2000