Caustic material ingestion: A five-year experience in a tertiary Toxicology Referral Center

Abstract

Significance:
Global epidemiologic data on caustic material ingestion (CMI) are scarce because of underreporting; yet it remains to be an important public health problem. Methodology: This is a retrospective cross-sectional study of adult patients admitted at the University of the Philippines-Philippine General Hospital (UP-PGH) for caustic ingestion from January 2013 to June 2018 which aims to determine incidence of caustic ingestion and clinico-demographic profile of patients. Severity of mucosal injury is mapped against the intervention done. In-patient mortality and surgery rates are determined.

Results:
This study shows that there were 80 caustic ingestion admissions per year at this institution from January 2013 to June 2018. A total of 399 admitted CMI cases were included, with 199 males (49.87%) and 200 females (50.13%), having a mean age of 32.67+13.14. Intentional ingestion is seen in majority of cases (n=332, 83.42%). Mortality is low (2%) and mostly related to acidic substance ingestion. Deaths are attributed to hospital acquired infection post-surgery. Acid ingestion cases have higher mortality (80%) than alkali ingestion. Injury to the esophagus is mostly 2A (36.4%). The most severely affected area of the stomach is the fundus at 42% (3A and 3B injuries). Surgical rate is 7%. Surgery showed that 92% of cases had 3B injuries to the cardia, fundus and body.

Conclusion:
Endoscopic evaluation is recommended. Assessment of severity of injury by Zargar classification is an important guide in the management of cases and imperative in decision making.