Death from caustic ingestion:A case report

Rationale:Acute caustic ingestion from suicidal intent is not usual in emergency departments in developed countries.One of the substances commonly ingested by suicidal patients,phosphoric acid,tends to cause multi-system derangements.Patient’s Concern:A 41-year-old male patient presented with complaints of throat discomfort,severe generalized abdominal pain,and multiple episodes of hematemesis after ingesting a restroom cleaning solution.Diagnosis:Poisoning by acute caustic ingestion(containing<30%phosphoric acid and<4%ethylene glycol).Interventions:The patient was administered 50 mL of 8.4%sodium bicarbonate solution followed by an isotonic sodium bicarbonate solution running at 500 mL/h,a hyperkalemia kit,ceftriaxone,metronidazole,omeprazole,and atropine.The patient then underwent urgent hemodialysis.Outcomes:The patient suffered gastrointestinal bleeding as a result of local caustic injury.In addition,his course of illness was complicated by severe acidemia from high anion gap metabolic acidosis and deranged electrolytes(hyperphosphatemia,hyperkalemia,and hypocalcemia).He developed multi-organ failure and eventually demised.Lessons:The clinician needs to be mindful of the multi-system complications arising from such a caustic ingestion.These patients need to be monitored closely for deterioration,and have prompt management of the various arising complications,to reduce the high morbidity and mortality associated with this condition.

Endoscopic Aspects of Caustic Injuries of the Upper Gastrointestinal Tract in Parakou, Benin Republic: A Multicenter Study

Objective: Caustic ingestion is a medico-surgical emergency. The objective of this study is to describe endoscopic lesions of the upper gastrointestinal tract secondary to caustic ingestion in Parakou, Benin Republic. Patients and Methods: This was a retrospective and descriptive cross-sectional study. The study was multicenter in the gastrointestinal endoscopy units of the Teaching Hospital Center of Borgou-Alibori and the Military Teaching Hospital of Parakou. It covered the period from July 2015 to October 2021. This included any patient who ingested a caustic substance and performed a gastroscopy in one of the two endoscopy units. The variables studied were: socio-demographic data, the nature of the caustic substance ingested, the time between the caustic ingestion and the performance of gastroscopy and injuries of the upper gastrointestinal tract. Results: Out of the 24 patients included, 19 were men, i.e. a sex ratio of 3.8. Their average age was 25.54 ± 12.04 years with extremes of 6 and 50 years. Five subjects (20.83%) were under the age of 18 and the ingestion was accidental in them. Among the 19 patients aged at least 18 years, caustic ingestion was voluntary in 14 (73.68%). The caustic substance ingested was either a base (sodium hydroxide or caustic soda) or an acid (sulfuric acid) in 14 cases (58.33%) and 10 cases (41.67%), respectively. The time between the caustic ingestion and the performance of gastroscopy varied from 1 to 1095 days. The endoscopic lesions objectified were: stenosis (37.5%), ulcerations (29.17%), necrosis (20.83%), or erythema (12.25%). Conclusion: In Parakou, caustic ingestion, usually bases, is often voluntary in adult men. Endoscopic lesions were often ulcerative but sometimes necrotic.

Management of esophageal caustic injury

Ingestion of caustic substances and its long-term effect on the gastrointestinal system maintain its place as an important public health issue in spite of the multiple efforts to educate the public and contain its growing number. This is due to the ready availability of caustic agents and the loose regulatory control on its production. Substances with extremes of pH are very corrosive and can create severe injury in the upper gastrointestinal tract. The severity of injury depends on several aspects: Concentration of the substance, amount ingested, length of time of tissue contact, and p H of the agent. Solid materials easily adhere to the mouth and pharynx, causing greatest damage to these regions while liquids pass through the mouth and pharynx more quickly consequently producing its maximum damage in the esophagus and stomach. Esophagogastroduodenoscopy is therefore a highly recommended diagnostic tool in the evaluation of caustic injury. It is considered the cornerstone not only in the diagnosis but also in the prognostication and guide to management of caustic ingestions. The degree of esophageal injury at endoscopy is a predictor of systemic complication and death with a 9-fold increase in morbidity and mortality for every increased injury grade. Because of this high rate of complication, prompt evaluation cannot be overemphasized in order to halt development and prevent progression of complications.

Dynamic caustics experimental study on interaction between propagating crack and deformity inclusions in primary structure

The approach combining the dynamic caustics method with high-speed photography technology is used to study the interaction between propagating cracks and three kinds of deformity inclusions（ cylinder inclusion, quadruple inclusion and triangular inclusion） under lowvelocity impact loading. By recording the caustic spots of crack tips at different moments during the crack propagation, the variation regulations of dynamic stress intensity factors（ DSIF） and crack growth velocity with respect to time are obtained. The experimental results showthat the resistance effects to crack growth are varied with different shapes of inclusions in specimens, and the quadruple inclusion＇s effect is more apparent. The distortion degree of caustic spots is affected by the shapes of inclusions as well, and the situation is more serious for cylinder and quadruple inclusions. The overall values of DSIFs of triangular inclusion specimen are greater than the others, and the crack growth velocities, characteristic sizes and DSIFs showprocesses of fluctuations because of the disturbance of reflection waves in specimens. The results provide an experimental basis for the analysis of strength and impact-resistance ability in structures with deformity inclusions.

Caustics study of the effect of glass fibres on dynamic fracture of hardened cement paste

The reflected optical caustics method is applied to study dynamic fracture problems in hardened cement paste. First both the unreinforced cement paste and the glass fibres reinforced cement paste specimens were fabricated and the reflective coating on the surface of the specimen was prepared. Secondly the crack path and the shadow spot patterns during the crack propagation process for the two specimens were recorded by using a multi-spark high speed camera.Thirdly some dynamic parameters of two cement paste specimens including crack onset time the dynamic stress intensity factor and crack growth velocity were determined and analyzed comparatively.This indicates that the glass fibres can improve the fracture resistance and delay fracture time.These results will play an important role in evaluating the dynamic fracture properties of cement paste.

Caustic injury of the upper gastrointestinal tract: A comprehensive review

Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. It is crucial to avoid malnutrition, especially in developingcountries where management strategies are influenced by malnutrition and poor clinical conditions. Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Possible late development of esophageal cancer, though probably overemphasized, entails careful and long-term endoscopic screening.

Predictability of outcome of caustic ingestion by esophagogastroduodenoscopy in children

AIM: To assess the necessity of esophagogastroduodenoscopy (EGD) to predict the outcome of caustic ingestion in children. METHODS: The study included 206 children who underwent EGD because of ingestion of caustic substances between January 2005 and August 2010. Retrospective analysis of data of the patients was performed. RESULTS: The male/female ratio was 1.6 and mean age was 38.1 ± 28.8 mo. The caustic substances were acidic in 72 (34.9%) cases, alkaline in 56 (27.2%), liquid household bleach in 62 (30.1%), and unknown in 16 (7.8%). Fifty-seven (27.7%) patients were symptom-free. Significant clinical findings were observed in 149 (72.3%) patients. Upper gastrointestinal endoscopy findings of esophageal injury were grade 0 in 86 (41.7%) patients, grade 1 in 49 (23.8%), grade 2a in 42 (20.4%), grade 2b in 28 (13.6%), and grade 3a in 1 (0.5%) patient. 35 patients with grade 2a, 2b, and 3a injuries underwent esophageal dilation at second week of ingestion. Esophageal stricture, which necessitated a regular dilation program developed in 13 of the aforementioned 35 patients. There is no statistically significant difference in the rate of development of esophageal stricture between the patients who ingested acidic (15.3%) and alkaline (8.9%) substances (P = 0.32). Severe gastric injury was detected in 38 (18.5%) patients. The rate of development of gastric injury was significantly higher in the acidic group (14%) than in the alkaline group (2.9%) (P = 0.001). Out of 149 patients with clinical findings, 49 (32.9%) patients had no esophageal injury and 117 (78.5%) patients had no gastric lesion. Esophageal and severe gastric injuries were detected in 20 (35.1%) and 8 (14%) of patients with no clinical findings respectively. Pyloric stenosis developed in 6 patients. Pyloric obstruction improved with balloon dilation in 2 patients. Mean hospitalization time were 1.2 ± 0.5 d for grade 0 and 2.3 ± 5 d for grade 1 and 6.3 ± 6.2 d for grade 2a and 15.8 ± 18.6 d for grade 2b. It was significantly longer for patients with grade 2a and 2b injuries (P = 0.000). CONCLUSION: Endoscopy is an effective technique for determining the presence of esophageal and gastric damage and to avoid unnecessary treatment in patients with no or mild injury.

CAUSTIC DECOMPOSITION OF SCHEELITE AND SCHEELITE－WOLFRAMITE CONCENTRATES THROUGH MECHANICAL ACTIVATION

Based on physicochemical study of the reaction between scheelite and NaOH, a new decomposition process for scheelite and scheelitewolframite concentrate, i. e., mechenically activating caustic decomposition has been developed, and it has been successfu

Dynamic caustics test of blast load impact on neighboring different cross-section roadways

Using digital laser dynamic caustics experimental system and conducting simulation experiment researched the influence rule of blasting excavation of a new roadway on neighboring existed different cross-section roadways. The experimental results show that the influence of blast load on adjacent roadway has a good relationship with the cross-section of roadway. The expansion distance of precrack existed in circular, arch-wall, rectangular roadway is respectively 1.76, 1.61 and 0 cm under blast load.At the same time, the direct-blast side of rectangular roadway has more obvious damage compared with circular and arch-wall roadway. It explains that plane reflects more stress wave than arc, so that it exerts more tensile failure in the direct-blast side, which leads to less stress wave diffracting to the precrack in the back-blast side. When the precrack extends, higher value dynamic stress intensity factor in circular roadway works longer than that of arch-wall roadway. Indirectly, it explains that plane's weakening function on stress wave is significantly stronger than arc. Stress wave brings about self-evident influence on the upper and bottom endpoints of the rectangular roadway, and it respectively extends 1.03, 2.06 cm along the line link direction of the center of the blasthole and the upper and bottom endpoints on the right wall.

Extraction of Zinc from Electric Arc Furnace Dust by Alkaline Leaching Followed by Fusion of the Leaching Residue with Caustic Soda

Extractability of zinc from two types of electric arc furnace (EAF) dusts containing 24.8% and 16.8% of zinc respectively (denoted as Sample A and Sample B) were tested using direct alkaline leaching followed by fusion of the resulting leaching residues with caustic soda. The experimental results show that the extraction of zinc is heavily dependent on the contents of iron in the dusts. The higher iron content, the lower extraction of zinc is obtained. 53% and 38% of zinc can be extracted when both dusts were directly contacted with 5mol·L^-1 NaOH solution for 42h. The remaining zinc left in the leaching residues, which supposed to be present as zinc ferrites, can be further leached when the residues were fused with caustic soda. Quantitative extraction of zinc can be obtained from the leaching residue of Sample A while only 85% from Sample B. The extractability of zinc from dusts wit hvarious contents of iron is compared. The production flowsheet for zinc from the dusts using the process proposed is discussed.

Reaction kinetics and mechanism of calcium oxide in dilute sodium aluminate solution with oxalate based on lime causticization

The formation kinetics and mechanism of tricalcium aluminate hydrate and calcium oxalate in dilute sodium aluminate solution and sodium oxalate solution were studied respectively based on the lime causticization, and the optimal conditions for removing the oxalate in dilute sodium aluminate solution as well as the mechanism were finally obtained.The formation processes of tricalcium aluminate hydrate and calcium oxalate are mainly controlled by the chemical reaction and the inner diffusion respectively,and the corresponding reaction rate equations as well as the apparent activation energy were calculated. The hydrocalumite with a spatially interleaved structure will form in dilute sodium aluminate solution with sodium oxalate, greatly removing the oxalate impurity by absorption. Calcium oxalate can be converted to tricalcium aluminate hydrate with the increasing reaction time. The oxalate causticization efficiency and the alumina loss rate can be over 90% and below 31% respectively when reacted at 50℃ with a stirring rate of 200 r/min.

Dynamic fracture behavior of rock under impact load using the caustics method

We studied the dynamic fracture mechanical behavior of rock under different impact rates. The fracture experiment was a three-point bending beam subjected to different impact loads monitored using the reflected caustics method. The mechanical parameters for fracture of the three-poim bending beam specimen under impact load are analyzed. The mechanism of crack propagation is discussed. Experimental results show that the dynamic stress intensity factor increases before crack initiation. When the dynamic stress intensity factor reaches its maximum value the crack starts to develop. After crack initiation the dynamic stress intensity factor decreases rapidly and oscillates. As the impact rate increases the cracks initiate earlier, the maximum value of crack growth velocity becomes smaller and the values of dynamic stress intensity factor also vary less during crack propagation. The results provide a theoretical basis for the study of rock dynamic fracture.

Role of endoscopy in caustic injury of the esophagus

Caustic injury of the esophagus is a problematic condition challenging endoscopists worldwide. Althoughthe caustic agents and motives are different among countries and age groups, endoscopy still plays an invaluable role in diagnosis and treatment. Endoscopy can determine the severity of caustic ingestion which is of great importance in choosing appropriate treatment. However, some aspects of endoscopy in diagnosis of caustic injury remain controversial. Whether or not all patients need endoscopy, when to perform endoscopy and how to assess the severity are just some examples of these controversies. Due to lack of randomized controlled trials, many findings and suggestions are inconclusive. Computerized tomography scan of the chest and abdomen gains popularity in assessing the severity of caustic injury and avoiding unnecessary surgery. If esophageal stricture eventually develops, endoscopic dilatation is a mainstay. Maneuvers such as steroid injection and esophageal stent may be used in a refractory stricture. Nevertheless, some patients have to undergo surgery in spite of vigorous attempts with esophageal dilatation. To date, caustic injury remains a difficult situation. This article reviews all aspects of caustic injury of the esophagus focusing on endoscopic role. Pre-endoscopic management, endoscopy and its technique in acute and late phase of caustic injury including the endoscopic management of refractory stricture, and the treatment outcomes following each endoscopic intervention are thoroughly discussed. Finally, the role of endoscopy in the long term follow-up of patients with esophageal caustic injury is addressed.

UV-catalytic treatment of spent caustic from ethene plant with hydrogen peroxide and ozone oxidation

The performance of UV/H 2O 2, UV/O 3 and UV/H 2O 2/O 3 oxidation systems for treating spent caustic from an ethylene plant was investigated. In UV/H 2O 2 system, with the increase of H 2O 2 dosage, removal efficiencies of COD and the ratio of biochemical oxygen demand(BOD) to chemical oxygen demand(COD) of the effluent were increased and a better performance was obtained than the H 2O 2 system alone. In UV/H 2O 2 system, removal efficiency of COD reach 68% under the optimum condition, and BOD/COD ratio was significantly increased from 0 22 to 0 52. In UV/O 3 system, with the increase of O 3 dosage, removal efficiency of COD and BOD/COD ratio were increased, and a better performance was obtained than the O 3 system alone. Under the optimum condition, removal efficiency of COD was 54%, and BOD/COD ratio was significantly increased from 0 22 to 0 48. In UV/H 2O 2/O 3 system, COD removal efficiency was found to be 22.0% higher than UV/O 3 system.

RAMAN SPECTRA OF SODIUM ALUMINATE SOLUTIONS WITH HIGH-CAUSTIC RATIO AND HIGH CONCENTRATION

The constitution of high-caustic ratio and highly concentrated sodium aluminate solutions has been investigated by Raman spectra method.By comparison with the Raman spectra of crystalline solids of Ca_3[Al(OH)_6]_2 and Ba_2[Al_2(OH)_(10)],it can be concluded that AI(OH)_6^(3-)ion and perhaps its polymers may be formed in these solutions.

Upgrading Paper-grade Softwood Kraft Pulp to Dissolving Pulp by Cold Caustic Extraction

Cold caustic extraction has potential applications in the production of dissolving-grade pulps due to its ability to selectively remove hemicellulose from lignocellulosic materials. In this study,we demonstrate the conversion of paper-grade kraft pulp into dissolving pulp by a single-stage cold caustic extraction. Under the extraction conditions of 12 wt% NaOH lye,11% pulp consistency,a temperature of 35℃,and 2 h,a paper-grade softwood kraft pulp was purified to high-grade dissolving pulp with 97. 1% α-cellulose content,1. 2% pentosane content,and narrowed molecular weight distribution. The resulting extraction filtrate was concentrated by nano-filtration to obtain the hemicellulose content of 59. 0 g / L,while the permeate was a clear Na OH solution with 10. 9 wt% concentration. A process configuration was also proposed,integrating this cold caustic extraction process with existing pulp and paper production and multi-purpose utilization of the extraction filtrate.

SPHERICAL NONLINEAR PULSES FOR THE SOLUTIONS OF NONLINEAR WAVE EQUATIONSⅡ, NONLINEAR CAUSTIC

This article discusses spherical pulse like solutions of the system of semilinear wave equations with the pulses focusing at a point and emerging outgoing in three space variables. In small initial data case, it shows that the nonlinearities have a strong effect at the focal point. Scattering operator is introduced to describe the caustic crossing. With the aid of the L^∞ norms, it analyzes the relative errors in approximate solutions.

A STUDY OF DYNAMIC CAUSTICS AROUND RUNNING INTERFACE CRACK TIP

Based on the first invariant of stress singular field in the vicinity of running tip of an interface crack, mapping equations of the caustic curve on the reference plane and the initial curve on the specimen plane are developed. The dynamic caustics are analyzed for the crack propagating along the interface between two bonded dissimilar materials. The variation of the caustic configurations is shown with the velocity change of the running crack and the ratio change of the stress intensity factors. Two characteristic dimensions are proposed that are not only practically measurable from optical caustic contours but also suitable to represent the behavior of transient caustics.

Esophageal Replacements for Caustic Esophageal Stenosis in Adults about 9 Cases in Ouagadougou

Objective: To report our experience of the esophageal plasty for caustic stenosis of the esophagus. Methods: Retrospective study of caustic stenosis of the esophagus in patients aged over 15 years, operated in Ouagadougou from 2008 to 2016. Nine patients were operated. Patients ranged in age from 25 to 53 years. Caustic ingestion was voluntary in 6 cases. Psychiatric disorders were confirmed in one case. The type of surgery and the postoperative evolution were analyzed. Results: In 6 patients the plasty was preceded by a gastrostomy or a feeding jejunostomy. The transplant, always placed in retro sternal position, was colic in 8 cases and gastric in one case. The evolution was marked by the occurrence of a cervical fistula in 5 cases, postoperative peritonitis in 2 cases, parietal suppuration in 2 cases and pneumothorax in 3 cases. One case of death was noted. After a follow-up of 6 months to 9 years, we noted a case of dysphagia. Conclusion: Esophageal plasty is a saving gesture that restores normal nutrition to the patient. It deserves to be promoted.

Treatment of spent caustic by three kinds of photocatalyticoxidation processes

The investigation of the performance of UV/H2O2, UV/O3 and UV/H2O2/O3 oxidation systems treating spent caustic from an ethylene plant shows that in UV/H2O2 system, with the increase of H2O2dosage, removal efficiencies of COD and the ratio of biochemical oxygen demand （BOD） to chemical oxygen demand （COD） of the effluent were increased and a better performance was obtained than the H2O2system alone. In UV/H2O2 system, removal efficiency of COD reached 68% under the optimum condition, and BOD/COD ratio was significantly increased from 0.22 to 0.52. In UV/O3 system, with the increase of O3dosage, removal efficiency of COD and BOD/COD ratio were increased, and a better performance was obtained than the O3system alone. Under the optimum condition, removal efficiency of COD was 54%, and BOD/COD ratio was significantly increased from 0.22 to 0.48. In UV/H2O2/O3 system, COD removal efficiency was found to be 22.0% higher than UV/O3 system.