Corrosive Poisoning: A Case Report
J. Sheethal
Nursing Supervisor, Kauvery Hospital, Tirunelveli, Tamil Nadu
Abstract
Corrosive poisoning occurs when a person ingests a corrosive chemical that damages tissue in the upper gastrointestinal tract. It can cause short-term and long-term complications, including perforation, strictures, and even cancer. Ingestion of corrosive substances may cause serious injuries to the upper gastrointestinal tract and the poisoning can also result in death. Acute corrosive intoxications pose a major problem in clinical toxicology since the most commonly affected population are the youth with psychiatric disorders, suicidal intent and alcohol addiction. The gold standard for determination of the grade and extent of the lesion is esophagogastroduodenoscopy performed in the first 12-24 hours following corrosive ingestion. The most common late complications are esophageal stenosis, antral and pyloric stenosis and rarely carcinoma of the upper gastrointestinal tract. Treatment of the acute corrosive intoxications includes neutralization of corrosive agents, antibiotics, anti-secretory therapy, nutritional support, collagen synthesis inhibitors, esophageal dilation and stent placement, and surgery.
Background
The term “corrosive” rather than “caustic” is used in this review as it better reflects the totality of chemical ingestions that can cause acute injury to the esophagus, stomach, pylorus, duodenum, and sometimes other organs. The most commonly ingested corrosive chemicals are strong acids and bases (pH <2 or >12) which can rapidly penetrate the various layers of the esophagus. Corrosive gastrointestinal tract injuries are a source of considerable mortality and morbidity all over the world. Despite this, the actual data on the epidemiology of the poisoning/ingestion are scarce due to lack of well-established reporting system for poisoning in most countries. The burden of this poisoning is naturally more in developing countries like India, where the condition is common because of poorly regulated sale of corrosive substances. The author here presents you a case of a young female who had accidental ingestion of the acid and complications, its management and with the review of management of corrosive ingestion.
Outcome
The outcome of corrosive poisoning can range from minor irritation to life-threatening complications, including esophageal and gastric perforations, strictures (narrowing of the esophagus or stomach), severe pain, difficulty in swallowing (dysphagia), malnutrition, and in severe cases, death; with the most common long-term complication being esophageal strictures due to scarring from the corrosive damage to the upper gastrointestinal tract.
Case Presentation
A 25 yrs aged female presented to a hospital with alleged history of ingestion of floor cleaner (content unknown) around 1000 ml around 10:30am on (09.01.2025) followed by burning sensation of throat and stomach. She had history of vomiting (+)-frothy secretions. She had NG Tube secured, gastric lavage and 1-pint bolus given, then referred here for further evaluation and management.
She had no history of loss of consciousness, seizures, ENT bleed, bowel and bladder disturbances. She had a recent alleged history of suicidal cut over throat on 5.01/2025 followed by profuse bleeding from injury site. She was treated at a hospital, where wound debridement and suturing were done on the same day. She was conscious, responding and tolerated oral nutrition. She had suicidal intention (+). She had psychiatric counselling and was on antianxiety drugs for 2 days. She also had history of S/P Myomectomy (6 months back) followed with abdominal pain for 3 months, consulted at multiple hospitals.
As she was anxious, restless, non-cooperative, refusing for treatment, attenders were counseled; patient was sedated and intubated. Glottis edema was noted, was ventilated in PCV Mode and continued treatment.
Clinical signs and symptoms
Symptoms of corrosive poisoning include:
- Pain
- Vomiting
- Drooling or hypersalivation
- Difficulty swallowing: Inability to swallow or difficulty swallowing (dysphagia)
- Breathing difficulties: Coughing, shortness of breath, stridor, tachypnea, or respiratory distress
- Shock
- Fever
- Rapid heart rate
- Rapid breathing
- Typical gastrointestinal manifestation
Diagnosis
Corrosive poisoning by self/Suicidal cut injury/Major depression/S/P Uterine myomectomy
Investigation
Lab reports
CT abdomen plain and with contrast
Chest X-ray
Barium study
Findings- normal
Management
- Patient was shifted to critical care unit for continuous monitoring.
- Nurses maintained every one-hour vital signs, intake and output chart.
- ENT Surgeon, gastroenterologist, plastic surgeon opinion was obtained and orders were carried out.
- Conservative management was followed as per psychiatric opinion.
- Consent for tracheotomy was obtained
- Soft cervical collar was placed in the neck for the patient.
- Patient had severe depression and complaints of pain over abdomen.
- Counselled about lower abdominal pain by consultant
- On 12/1/25, RT Feeds was initiated, Patient tolerated well, and extubation was planned after weaning support.
- Patient was extubated, post extubation care given, RT feed was continued.
- Oral feed was initiate and encouraged
- The patient had frequent complaints of abdominal pain, neck pain from cut injury even with adequate analgesics.
- RT was removed and patient tolerated with oral feeds.
- On 17/1/25, Patient started to improve gradually with stable vital signs along with clinical improvement
- Counseling was given to patient about discharge
- Psychiatrist and surgical gastroenterologist reviewed and orders were followed.
- RT was removed and Patient tolerated the oral feeds well.
- On 18/1/25- patient started to improve gradually with stable vital signs along with clinical improvement.
- So Patient was discharged on 19/1/25 and advised for strict 24 hr vigilance at home and was discharged with following medical and psychological advice.
- Advised the attenders to monitor for any signs and symptoms of depression and suicidal thoughts.
- Positive reinforcement provided to patient
- Advised to take medicine properly. Regularly Educated about to take high protein, high fiber and vitamin C food.
- Educated about deep breath exercise when feel anxious.
- Endoscopy is planned after two weeks.
Medication
| SI. No | Drug name | Strength | Frequency | Route of administration | Relationship with meal | Days | ||
|---|---|---|---|---|---|---|---|---|
| M | A | N | ||||||
| 1. | T. Quitipin | 500 mg | 0 | 0 | 1 | Oral | After food | 5 Days |
| 2. | T. Tryptomer | 50 mg | 0 | 0 | 1 | Oral | After food | 5 Days |
| 3 | T. Tryptomer | 25 mg | 1 | 0 | 0 | Oral | After food | 5 Days |
| 4 | T. Nitravet | 10 mg | 0 | 0 | 1 | Oral | After food | 5 Days |
| 5 | T. Mitraz | 1.5 | 0 | 0 | 1 | Oral | After food | 5 Days |
| 6 | T. Lonazep MD | 0.5 mg | 1 Tablet | Oral | After food | SOS | ||
Conclusion
Patient came for review after a week and is doing well and is under psychiatric follow up. Ingestion of corrosive chemical substances can result in devastating GI tract injuries with the risk of perforation and/or hemorrhage and sometimes potentially fatal systemic complications.
References
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