bp pgd caustic

8/10/2019 Bp Pgd Caustic

1/36

CAUSTIC

POISONING INGESTION

YENI H RY NI

PEDIATRIC EMERGENCYSUBDIVISION

LITER TURE REVIEW

1


2/36

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.

2


3/36

Caustic

agents

Alkaline

pH>7

Accepting proton

Acid

pH


4/36

Epidemiology

200.000 cases/yr

Household product

US Poisoncentre

148 children Dec2005-July 2008

Italy

Glacial acetic acidEast Asia

4


5/36

Insidens

Accidental poisoning

Liquid form

Children


6/36

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

6


7/36

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


8/36

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

8


9/36

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

9


10/36

Radiologyc Examination

chest x-ray :pneumomediastinum, pleuraleffusion, pneumoperitoneum,

foreign bodiesPlain abdomen :

pneumoperitoneum, ascites,foreign bodies, perforation

CT-scan : extralumen air10


11/36

E n d o s c o p y

Timing :1st: 24 hour after ingestion

2nd: 3-4 weeks later

ClassificationIndication

11


12/36

History

Physical examinationSupportive

examination

Diagnosis

Burn injury

Gastrointestinalbleeding

Differentialdiagnosis

12


13/36


14/36

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

14


15/36

... Hospital Management

dilution

Do not do neutralisir

Intravenous access,blood

15


16/36

...hospital management

Medication

drugs

Corticosteroid

antibiotic

Antacida,H2Blocker, PPI

Analgesicnarcotic

Indication

16


17/36

...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

17


18/36

MANAGEMENT SUMMARY

18


19/36

E

R

L

Y

C

O

M

P

L

I

C

T

I

O

N

Airwayobstruction

perforation

Mediastinitispleuritis

Gastrointestinal bleeding

Cardiacarrest

syok

peritonitis 19


20/36

Late

Complication

Esophagealstrictur

Squamouscell

carcinoma

20


21/36

P R O G N O S I S

Tissue injury

Treatment : basic,symptomatic,supportivetreatment

Anticipatecomplication

Stricturesophagal:

Squamous cellcarcinoma

Death

21


22/36

CONSULT TION

Surgery: perforation, peritonitis

Endoscopy : indication

Poison Control Centre

Psikiatri : suicide attempt

22


23/36

PREVENTION

Parents :

Caustic agentsstore in child

resistant containers

Industrialcorporation:

Reduced

concentration ofhousehold product

23


24/36

CONTROVERSION

SteroidAntibiotic

Endoscopy

24


25/36

MANAGEMENT PATHWAY

Suspected poisoningAnd treatment

Poison Control Centre

Indonesia

25


26/36

SUMM RY

Caustic Poisoning Ingestion may

cause devastating injury inchildren. Stepwise care approachinclude: diagnosis, treatment, and

anticipate complication are helpfulin successful management.

26


27/36

27

TH NK YOU


28/36

28

Endoscopic view of the

esophagus in a patient whoingested hydrochloric acid


29/36

Zargar Endoscopic Classification Scheme for Caustic mucosal

Injury

29

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


30/36

Indication for Endoscopic

30

Small children

Simptomatic older children & adult

Patient with altered mental status

Patient with intentional ingestion

Patient with potential for significantinjury


31/36

Medical therapy in caustic ingestion

31


32/36

Management of caustic injury

32


33/36

P i t l t i I d i


34/36

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

34
mailto:[email protected]:[email protected]:[email protected]:[email protected]


35/36


36/36

bp pgd caustic

Documents