RESUMO
Antecedentes. La ingesta de sustancias cáusticas en pediatría constituye una causa frecuente de atención médica en Urgencias. El uso indiscriminado de limpiadores químicos y la facilidad de adquisición son factores determinantes para estas lesiones. Población y métodos. Estudio descriptivo analítico. Se incluyeron niños < 16 años, entre enero de 1998 y diciembre de 2017. Se identificó el agente químico cáustico ingerido por el niño como ácido o alcalino. Se realizó una endoscopía digestiva para tipificar el grado de quemadura. Se comparó el grado de quemadura con el tipo de cáustico; por medio de la prueba de chi² o exacta de Fisher, se consideró significativo el valor de P < 0,05. Resultados. Ingresaron 133 niños en Urgencias por ingesta de cáusticos. El agente cáustico fue ácido en el 41 % y alcalino en el 59 %. El agente ácido más frecuente fue el ácido muriático (36,8 %), mientras que el alcalino fue la sosa (soda) cáustica (41,4 %). La quemadura del esófago fue más frecuente en la ingesta de sosa en comparación con otros cáusticos (p= 0,001), mientras que la quemadura del estómago (p= 0,001) y del duodeno (p= 0,002) fue estadísticamente significativa en la ingesta de ácido muriático. El grupo de edad que más frecuentemente ingirió algún cáustico (93,2 %) fueron los menores de 5 años. Conclusiones. El cáustico ingerido con mayor frecuencia fue un agente alcalino, que provocó quemadura esofágica, mientras que un agente ácido provocó quemaduras en el estómago y el duodeno evidenciadas por endoscopía.
Background. Caustic ingestion in pediatrics is a common cause of visits to the Emergency Department. An indiscriminate use of cleaning chemicals and an easy access to them are determining factors for these injuries. Population and methods. Descriptive, analytical study. Children aged < 16 years hospitalized between January 1998 and December 2017 were included. The ingested caustic substance was identified as acid or alkaline. A gastrointestinal endoscopy was done to establish the burn grade. The grade of the burn was compared to the type of caustic substance using the χ² test or the Fisher's exact test; a P value < 0.05 was considered significant. Results. A total of 133 children were admitted to the Emergency Department due to caustic ingestion. The caustic agent was acid in 41 % of cases and alkaline, in 59 %. The most common acid caustic substance was muriatic acid (36.8 %) and the most common alkaline caustic agent was caustic soda (41.4 %). An esophageal burn was the most common consequence of caustic soda ingestion compared to other caustic agents (p = 0.001), whereas muriatic acid ingestion was the most statistically significant cause of stomach burn (p = 0.001) and duodenal burn (p = 0.002). The age group that most commonly ingested some caustic agent (93.2 %) corresponded to children younger than 5 years. Conclusions. The most common type of ingested caustic agent was alkaline, which caused esophageal burn; whereas, the ingestion of an acid caustic substance caused stomach and duodenal burns, as evidenced by endoscopy.
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Queimaduras Químicas/diagnóstico , Cáusticos/intoxicação , Endoscopia Gastrointestinal/métodos , Trato Gastrointestinal/lesões , Estômago/lesões , Ácidos/intoxicação , Queimaduras Químicas/etiologia , Queimaduras Químicas/epidemiologia , Epidemiologia Descritiva , Fatores Etários , Duodeno/lesões , Álcalis/intoxicação , Serviço Hospitalar de Emergência , Esôfago/lesõesRESUMO
BACKGROUND: Caustic ingestion in pediatrics is a common cause of visits to the Emergency Department. An indiscriminate use of cleaning chemicals and an easy access to them are determining factors for these injuries. POPULATION AND METHODS: Descriptive, analytical study. Children aged < 16 years hospitalized between January 1998 and December 2017 were included. The ingested caustic substance was identified as acid or alkaline. A gastrointestinal endoscopy was done to establish the burn grade. The grade of the burn was compared to the type of caustic substance using the χ2 test or the Fisher's exact test; a P value < 0.05 was considered significant. RESULTS: A total of 133 children were admitted to the Emergency Department due to caustic ingestion. The caustic agent was acid in 41 % of cases and alkaline, in 59 %. The most common acid caustic substance was muriatic acid (36.8 %) and the most common alkaline caustic agent was caustic soda (41.4 %). An esophageal burn was the most common consequence of caustic soda ingestion compared to other caustic agents (p = 0.001), whereas muriatic acid ingestion was the most statistically significant cause of stomach burn (p = 0.001) and duodenal burn (p = 0.002). The age group that most commonly ingested some caustic agent (93.2 %) corresponded to children younger than 5 years. CONCLUSIONS: The most common type of ingested caustic agent was alkaline, which caused esophageal burn; whereas, the ingestion of an acid caustic substance caused stomach and duodenal burns, as evidenced by endoscopy.
Antecedentes. La ingesta de sustancias cáusticas en pediatría constituye una causa frecuente de atención médica en Urgencias. El uso indiscriminado de limpiadores químicos y la facilidad de adquisición son factores determinantes para estas lesiones. Población y métodos. Estudio descriptivo analítico. Se incluyeron niños < 16 años, entre enero de 1998 y diciembre de 2017. Se identificó el agente químico cáustico ingerido por el niño como ácido o alcalino. Se realizó una endoscopía digestiva para tipificar el grado de quemadura. Se comparó el grado de quemadura con el tipo de cáustico; por medio de la prueba de chi2 o exacta de Fisher, se consideró significativo el valor de P < 0,05. Resultados. Ingresaron 133 niños en Urgencias por ingesta de cáusticos. El agente cáustico fue ácido en el 41 % y alcalino en el 59 %. El agente ácido más frecuente fue el ácido muriático (36,8 %), mientras que el alcalino fue la sosa (soda) cáustica (41,4 %). La quemadura del esófago fue más frecuente en la ingesta de sosa en comparación con otros cáusticos (p= 0,001), mientras que la quemadura del estómago (p= 0,001) y del duodeno (p= 0,002) fue estadísticamente significativa en la ingesta de ácido muriático. El grupo de edad que más frecuentemente ingirió algún cáustico (93,2 %) fueron los menores de 5 años. Conclusiones. El cáustico ingerido con mayor frecuencia fue un agente alcalino, que provocó quemadura esofágica, mientras que un agente ácido provocó quemaduras en el estómago y el duodeno evidenciadas por endoscopía.
Assuntos
Queimaduras Químicas/diagnóstico , Cáusticos/intoxicação , Endoscopia Gastrointestinal/métodos , Trato Gastrointestinal/lesões , Ácidos/intoxicação , Adolescente , Fatores Etários , Álcalis/intoxicação , Queimaduras Químicas/epidemiologia , Queimaduras Químicas/etiologia , Criança , Pré-Escolar , Duodeno/lesões , Serviço Hospitalar de Emergência , Esôfago/lesões , Feminino , Humanos , Lactente , Masculino , Estômago/lesõesRESUMO
All admissions to the Paediatric wards of the University Hospital of the West Indies for the 12-year period, February 25, 1961 to February 28, 1973, have been examined. 130 cases of poisoning or drug overdosage were admitted during this period. 101 children (78 percent) were between the ages 1 and 4 years. The yearly incidence of admissions varied from only one case in 1962 to 18 in 1971, and 60 percent of them were admitted in the latter half of the study period. Kerosene ingestion resulting in aspiration pneumonitis was the commonest cause of poisoning. Only 2 cases of salicylate poisoning were admitted - one was mildly affected while the other due to ingestion of 'oil of winter-green' was of modern severity. Phenothiazines (13 cases), acid or caustic substances (11 cases), ferrous sulphate (10 cases), barbiturates (7 cases), ackee with toxic hypoglycaemia (6 cases), digoxin (5 cases) and organic phosphate insecticides (5 cases) accounted for most of the other admissions. 2 cases of lead poisoning and 2 children with severe vomiting and diarrhoea due to ingestion of 'Physic nut' (Jatropha curcas) were admitted and there were single cases of poisoning from a variety of toxic substances including napthalene (camphor balls), oil of chenopodium and nitrobenzene. One child was admitted following an overdose of lignocaine administered in Casualty for local anaesthesia and another from linctus codeine given for diarrhoea. 5 patients died, one from severe pneumonitis. 3 from toxic hypoglycaemia and the 5th from an unknown poison. Examination of the admission records of all children admitted to the Casualty Observation ward during a 20-month period, 1971-1972, revealed 54 cases of poisoning. 37 of these were due to kerosene ingestion and only 2 of these were admitted to the ward, the others being discharged after 1 to 3 days of observation. Many milder cases of poisoning are seen in Casualty and treated and sent home without further observation (AU)