Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
CAUSTIC
POISONING INGESTION
YENI HARYANI
PEDIATRIC EMERGENCY
SUBDIVISION
1
INTRODUCTION
Caustic
agents
Alkaline
Acid
pH>7
pH<7
Accepting proton
Donating proton
Epidemiology
US Poison
centre
Italy
East Asia
200.000 cases/yr
Household product
148 children Dec
2005-July 2008
Insidens
Children
<5yr
Teenager
& adult
Accidental poisoning
Liquid form
Intentional poisoning,
suicide attempt
Mortality & morbidity
inscrease
CAUSES
Alkaline
NaOH, KOH : drain
cleaner, oven cleaner,
clini tablet, dental
cleaner
CaOH: cement, plester
Na hipochlorite, Ca
hipochlorite: bleaches,
clor solution
Amonia: 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, glass
cleaner
HCl: toilet cleaner,
swimpool cleaner,
laboratory equipment
cleaner
Acetic acid: decinfectant
PATHOPHYSIOLOGY
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 and
coagulation
abdomen is the most
involved organ
CLINICAL MANIFESTATION
History
Dyspnea, disfagia,
odinofagia
Physical
examination
Airway obstruction
Burns on orofaring
drooling,
Chest pain,
abdominal pain,
nausea, vomiting
Acute peritonitis
haematemesis
Syok, mental abnormal
8
WORK UP
Laboratory:
pH of substance ingestion
pH of saliva
CBC, electrolyte, BUN,
creatinin, BGA
Liver function test, DIC test
Urinalysis, urine output
9
Radiologyc Examination
chest x-ray :
pneumomediastinum, pleural
effusion, pneumoperitoneum,
foreign bodies
Plain abdomen :
pneumoperitoneum, ascites,
foreign bodies, perforation
CT-scan : extralumen air
10
Endoscopy
Timing :
1st: 24 hour after ingestion
2nd: 3-4 weeks later
Classification
Indication
11
Diagnosis
Differential
diagnosis
History
Physical examination
Supportive
examination
Burn injury
Gastrointestinal
bleeding
12
PREHOSPITAL MANAGEMENT
Identification of ingestion product
Timing of treatment, duration of contact
Do not to induce emesis or neutralizir
Active charcoal is not efective
Dilution
13
HOSPITAL MANAGEMENT
Airway Control
Airway and mental status
assesment
Endotrachea, cricotiroitomi
intubation
Do not do neutralisir
Intravenous access,
blood
15
...hospital management
Cortico
steroid
antibiotic
drugs
Antacida,
H2Blocker, PPI
Medication
Indication
Analgesic
narcotic
16
Gastrostomy
Parenteral nutrition: CVP
EBD,
bouginase
esophageal
Mitomycin C
MANAGEMENT SUMMARY
18
Airway
obstruction
C
O
perforation
A L
R
L C
Y A
T
I
O
Mediastinitis
pleuritis
Gastrointesti
nal bleeding
Cardiac
arrest
syok
peritonitis
19
Late
Complication
Esophageal
strictur
Squamous
cell
carcinoma
20
PROGNOSIS
Tissue injury
Treatment : basic,
symptomatic,
supportive
treatment
Anticipate
complication
Strictur
esophagal:
Squamous cell
carcinoma
Death
21
CONSULTATION
PREVENTION
Parents :
Industrial
corporation:
Caustic agents
store in child
Reduced
resistant containers concentration of
household product
23
CONTROVERSION
Steroid
Antibiotic
Endoscopy
24
MANAGEMENT PATHWAY
Suspected poisoning
And treatment
Indonesia
25
SUMMARY
Caustic Poisoning Ingestion may
cause
devastating
injury
in
children. Stepwise care approach
include: diagnosis, treatment, and
anticipate complication are helpful
in successful management.
26
THANK YOU
27
Grade 0 :Normal
Grade I: edema, hyperemic
31
32
33
Bandung
Poison Information Health Service - West Java
Jl Pasteur No. 25
Bandung
Director: Dra Hj Sri Sulastri
Telephone: +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: pusatiomker@cbn.net.id or informasi@pom.go.id
Surabaya
Poison 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
34
Gastrostomy
35
Gastrostomy
36