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.

Accidental ingestion of foreign bodies/harmful materials in children from Bahrain:A retrospective cohort study

BACKGROUND Children like to discover their environment by putting substances in their mouths.This behavior puts them at risk of accidentally ingesting foreign bodies(FBs)or harmful materials,which can cause serious morbidities.AIM To study the clinical characteristics,diagnosis,complications,management,and outcomes of accidental ingestion of FBs,caustics,and medications in children.METHODS We conducted a retrospective cohort study of all children admitted for accidental ingestion to the Department of Pediatrics,Salmaniya Medical Complex,Bahrain,between 2011 and 2021.Demographic data,type of FB/harmful material ingested,and investigations used for diagnosis and management were recorded.The patients were divided into three groups based on the type of ingested material(FBs,caustics,and medications).The three groups were compared based on patient demographics,socioeconomic status(SES),symptoms,ingestion scenario,endoscopic and surgical complications,management,and outcomes.The FB anatomical location was categorized as the esophagus,stomach,and bowel and compared with respect to symptoms.The Fisher’s exact,Pearson’s χ^(2),Mann-Whitney U,and Kruskal-Wallis tests were used for comparison.RESULTS A total of 161 accidental ingestion episodes were documented in 153 children.Most children were boys(n=85,55.6%),with a median age of 2.8(interquartile range:1.8-4.4)years.Most participants ingested FBs(n=108,70.6%),31(20.3%)ingested caustics,and the remaining 14(9.2%)ingested medications.Patients with caustic ingestion were younger at the time of presentation(P<0.001)and were more symptomatic(n=26/31,89.7%)than those who ingested medications(n=8/14,57.1%)or FBs(n=52/108,48.6%)(P<0.001).The caustic group had more vomiting(P<0.001)and coughing(P=0.029)than the other groups.Most FB ingestions were asymptomatic(n=55/108,51.4%).In terms of FB location,most esophageal FBs were symptomatic(n=14/16,87.5%),whereas most gastric(n=34/56,60.7%)and intestinal FBs(n=19/32,59.4%)were asymptomatic(P=0.002).Battery ingestion was the most common(n=49,32%).Unsafe toys were the main source of batteries(n=22/43,51.2%).Most episodes occurred while playing(n=49/131,37.4%)or when they were unwitnessed(n=78,57.4%).FBs were ingested more while playing(P<0.001),caustic ingestion was mainly due to unsafe storage(P<0.001),and medication ingestion was mostly due to a missing object(P<0.001).Girls ingested more jewelry items than boys(P=0.006).The stomach was the common location of FB lodgment,both radiologically(n=54/123,43.9%)and endoscopically(n=31/91,34%).Of 107/108(99.1%)patients with FB ingestion,spontaneous passage was noted in 54(35.5%),endoscopic removal in 46(30.3%),laparotomy in 5(3.3%)after magnet ingestion,and direct laryngoscopy in 2(1.3%).Pharmacological therapy was required for 105(70.9%)patients;79/105(75.2%)in the FB group,22/29(75.9%)in the caustic group,and 4/14(28.8%)in the medication group(P=0.001).Omeprazole was the commonly used(n=58;37.9%)and was used more in the caustic group(n=19/28,67.9%)than in the other groups(P=0.001).Endoscopic and surgical complications were detected in 39/148(26.4%)patients.The caustic group had more complications than the other groups(P=0.036).Gastrointestinal perforation developed in the FB group only(n=5,3.4%)and was more with magnet ingestion(n=4)than with other FBs(P<0.001).In patients with FB ingestion,patients aged<1 year(P=0.042),those with middle or low SES(P=0.028),and those with more symptoms at presentation(P=0.027)had more complications.Patients with complications had longer hospital stays(P<0.001)than those without.CONCLUSION Accidental ingestion in children is a serious condition.Symptomatic infants from middle or low SES families have the highest morbidity.Prevention through parental education and government legislation is crucial.

Z-line examination by the PillCam^(TM) SB:Prospective comparison of three ingestion protocols

AIM:To evaluate the Z-line visualization by the PillCamTM SB2 using three different ingestion protocols. METHODS:Ninety consecutive patients undergoing small bowel capsule endoscopy(SBCE)between January and May 2008 were included in the study. They swallowed the capsule in the standing(Group A= 30),supine(Group B=30)and right supine positions (Group C=30).Baseline patient characteristics, difficulties in capsule ingestion,esophageal transit times(ETT)and Z-line visualization were noted. RESULTS:No significant differences were found between the groups with regard to baseline patient characteristics,ingestion difficulties and complete SB examinations(P>0.05).At least 1 frame of the Z-line was detected in 15.8%,46.7%and 90%of patients in groups A,B and C,respectively(P<0.001).The average number of Z-line images was 0.21±0.53,3.23 ±6.59 and 5.53±7.55 and the mean%of the Z-linedetected was 71.3,25.1 and 8.3,in groups A,B and C, respectively(both P<0.001).ETT times were longer in the supine group followed by the right supine and the standing groups(median of 237 s vs 64 s and 39 s, respectively;P<0.001). CONCLUSION:Z-line visualization in patients undergoing SBCE can be accurately achieved in most cases when the capsule is swallowed in the right supine position.

Intentional ingestions of foreign objects among prisoners: A review

The intentional ingestion of foreign objects(IIFO) is described more commonly in prison populations than in the general population, with an estimated annual incidence of 1 in 1900 inmates in our state correctional facilities. Incidents often involve ingestion of small metal objects(e.g., paperclips, razor blades) or other commonly available items like pens or eating utensils. Despite ingestion of relatively sharp objects, most episodes can be clinically managed with either observation or endoscopy. Surgery should be reserved for those with signs or symptoms of gastrointestinal perforation or obstruction. For those with a history of IIFO, efforts should focus on prevention of recurrenceas subsequent episodes are associated with higher morbidity, significant healthcare and security costs. The pattern of IIFO is often repetitive, with escalation both in frequency of ingestions and in number of items ingested. Little is known about successful prevention strategies, but efforts to monitor patients and provide psychiatric care are potential best-practice strategies. This article aims to provide state-of-the art review on the topic, followed by a set of basic recommendations.

Knowledge of aflatoxin contamination in groundnut and the risk of its ingestion among health workers in Ibadan,Nigeria

Objective:To assess the awareness and knowledge of aflatoxin contamination in groundnut and the risk of its ingestion among health workers in Ibadan.Methods:The study was a descriptive cross-sectional study.Study instrument was a semi-structured self administered questionnaire. The respondents were health workers from a public health facility.Results:A total of 417 health workers participated out of which males were 60.2%.The mean age of respondents was(28.0±4.9) years old.Doctors made up 83.0%while others were nurses.95%of the respondents had previous awareness of aflatoxin and class room lectures was the most common source of information(56%).Occupation and religion both showed a significant association with previous awareness of aflatoxin(P<0.05).Knowledge regarding aflatoxin contamination in groundnut and the risk of its ingestion was obtained showing knowledge score range of 0 to 14.In all,80.6%had good scores of 11 to 14.None of the respondents had ever told their patients about the risk of aflatoxin ingestion. Conclusions:There is a need to explore the possibility of incorporating aflatoxin awareness into routine health talk to increase the level of awareness of patients and their relatives.

Comparison of the effects of cold water and ice ingestion on endurance cycling capacity in the heat

Purpose: The purpose of this study was to examine the effects of pre-cooling and fluid replacement with either crushed ice or cold water.Methods: On 2 separate occasions, in a counterbalanced order, 9 recreationally-trained males ingested 1.25 g/kg(80–100 g) of either crushed ice(0.5℃)or cold water(4℃) every 5 min for 30 min before exercise. They also ingested 2.0 g/kg(130–160 g) of the same treatment drink at 15 min, 30 min, and45 min after the commencement of cycling to exhaustion at 60%VO_(2max) until voluntary exhaustion in a hot environment(35℃ and 30% relative humidity).Results: The cycling time to exhaustion in the crushed ice trial(50.0 ± 12.2 min) was longer than the cold water trial(42.2 ± 10.1 min; p = 0.02).Although the rectal temperature fell by 0.37℃± 0.03℃(p = 0.01) at the end of the resting period after the crushed ice ingestion, the rates of rise in rectal temperature during the exercise period were not significantly different between these 2 conditions(crushed ice: 0.23℃± 0.07℃, 5 min;cold water: 0.22℃± 0.07℃, 5 min; p = 0.94).Conclusion: Crushed ice ingestion before and during exercise in a hot environment may be a preferred and effective approach for minimizing thermal strain, and for improving endurance performance as compared with cold water ingestion.

Hydrogen peroxide ingestion with injury to upper gastrointestinal tract

Hydrogen peroxide is a common over-the-counter solution that has developed a growing body of literature regarding toxic ingestion. Intentional ingestion of high concentration hydrogen peroxide for health purposes has gained popularity in certain patient populations; purported benefits are due to the increased oxygen released into the blood stream. We present for evaluation one such case with associated imaging that presented to our urban medical center. A brief review of the literature was also performed noting current recommendations regarding both outcomes and indications for endoscopy as well as hyperbaric oxygen therapy following ingestion of hydrogen peroxide. Our patient was a 51-year-old white female who presented with foamy hematemesis after ingesting 10 drops of 35% hydrogen peroxide as part of a home remedy to cleanse her colon and improve blood oxygenation. In addition to hematemesis,she also reported diffuse abdominal pain with sore throat and hoarse voice. Her imaging demonstrated portal venous gas and gastric edema. She was admitted for hyperbaric oxygen therapy and underwent upper endoscopy demonstrating diffuse esophagitis and gastritis with white exudate and multiple petechiae. She was later discharged home in stable condition and was lost to follow-up.

X-ray diagnosis with a bloating agent for foreign object ingestion

The location of an ingested foreign object is often difficult to determine by X-ray if gastric air bubbles are not clear in the image.Methods that provide negative contrast can facilitate precise object localization,which is important for object retrieval and treatment of the patient.This case report describes a male child,2 years and 2 mo of age,who accidentally swallowed a lithium battery while playing at home.A plain X-ray showed that the battery was in the abdomen,but it was unclear whether the object was still inside the stomach.A second X-ray examination performed after oral administration of a bloating agent to produce expansion of the stomach and provide negative contrast confirmed that the ingested battery was still in the stomach.The battery was then carefully removed using magnetic and balloon catheters under fluoroscopic guidance.This case report describes the successful use of an orally administered bloating agent without pain to the child in orderto determine the precise location of a foreign object in the abdomen.

Development Strategy of Engine Bird Ingestion Certification Technology

The development strategy of the certification technology on engine bird ingestion is proposed after reviewing the development history of engine bird ingestion certification in developed Western countries,and analyzing technical characteristics during different developing periods.Moreover,the main issues of bird ingestion certification technology,development program and strategy for the turbofan engines industry are addressed in detail.Finally,the relevant technique development is investigated and the main objects of bird ingestion certification technology for the turbofan engines are summarized and concluded.

Estimation of Annual Effective Dose Due to Ingestion of Natural Radionuclides in Cattle in Tin Mining Area of Jos Plateau, Nigeria

Contamination of land could occur during the extraction and handling of materials containing high levels of naturally occurring radionuclide materials. These radionuclides find their ways into the food chain. The activity concentrations of natural radionuclides 40K, 226Ra, and 232Th in heart, liver, kidney, lungs, spleen and beef of cattle slaughtered and consumed in a tin mining area of Jos Plateau, Nigeria were determined by gamma ray spectroscopy method. The activity concentration of 40K is the highest in all the samples. The annual effective dose to man through the ingestion of the radionuclides in the organs was estimated. The mean annual effective doses calculated are 35.35 ± 13.84, 57.89 ± 38.27 and 46.93 ± 10.28 μSv?y?1 for heart, liver and kidney, respectively. Those of lungs, spleen and meat are 28.44 ± 15.70, 48.34 ± 28.85 and 41.24 ± 3.56 μSv?y?1, respectively. These are of the order of two magnitudes higher than those obtained for food in Abeokuta, Nigeria.

Effects of Food Diet Preparation Techniques on Radionuclide Intake and Its Implications for Individual Ingestion Effective Dose in Abeokuta, Southwestern Nigeria

The radioactivity measurements in food crops and their diet derivatives and farm soil samples from Abeokuta, one of the elevated background radiation areas in Nigeria have been carried out in order to determine the concentration levels of natural radionuclides (40K, 226Ra and 232Th). The activity concentrations of the natural radionuclides in the samples were determined via gamma-ray spectrometry using a 76 mm × 76 mm NaI(Tl) detector. Different common food crops representing the major sources of dietary requirements to the local population were collected for the measurements. The collected food crops were prepared into their different derivable composite diets using preparation techniques locale to the population. Using available food consumption data and the activity concentrations of the radionuclides, the ingestion effective doses were evaluated for the food crops and diet types per preparation techniques. For the tuberous food crop samples, the annual ingestion effective doses in the raw and different composite diets were 0.02 - 0.04 μSv and cumulatively 0.04 - 0.05 μSv while in the non-tuberous crops the doses were 0.44 - 0.70 μSv and cumulatively greater than 1 μSv respectively. Results of the study indicate that method of diet preparation is seen to play a major role in population ingestion dose reduction especially for tuberous crops than in non-tuberous crops. The study also showed that more ingestion dose could be incurred in diets prepared by roasting techniques. The result of the study will serve as a useful radiometric data for future epidemiological studies in the area and for food safety regulations and policy implementations in the country.

STUDIES ON THE INGESTION CHARACTERISTICS OF GIANT FRESHWATER PRAWN, CHINESE PRAWN AND GIANT TIGER PRAWN

The ingestion of giant freshwater prawn, Chinese prawn and giant tiger prawn had continuity and the ingestion high peak occurred at night. Light and temperature had significant effects on the daily ingestion rate (DIR) of giant freshwater prawn Macrobrachium rosenbergii . Red light and blue light favorably induced favorable ingestion. In the adaptive range of temperature, the DIR increased with rising temperature and feeding frequency, but decreased with rising body weight.

Rectal perforation by inadvertent ingestion of a blister pack: A case report and review of literature

The accidental ingestion of a foreign body(FB) is a relatively common condition. In the present study, we report a peculiar case of rectal perforation, the first to our knowledge, caused by the inadvertent ingestion of a blister pill pack. The aim of this report is to illustrate the difficulties of the case from a diagnostic and therapeutic viewpoint as well as its unusual presentation. A 75-year-old woman, mentally impaired, arrived at our emergency department in critical condition. The computed tomography scan revealed a substantial abdominopelvic peritoneal effusion and free perigastric air. The patient was therefore submitted to an urgent exploratory laparotomy; a 2-cm long, full-thickness lesion was identified in the anterior distal part of the intraperitoneal rectum. Hence, we performed a Hartmann's procedure. Because of her critical condition, the patient was eventually transferred to the Intensive Care Unit, where she died after 10 d, showing no surgical complication. The ingestion of FBs is usually treated with observation or endoscopic removal. Less than 1% of FBs are likely to cause an intestinal perforation. The intestinal perforation resulting from the unintentional ingestion of an FB is often a difficult challenge when it comes to treatment, due to its late diagnosis and the patients' deteriorated clinical condition.

Laparoscopic retrieval of two intragastric spoons at least seven years after ingestion

Foreign body ingestion is a commonly encountered presentation.The majority of foreign bodies pass in stool spontaneously within one week or are managed endoscopically within the first 24e48 hours.No guidelines are available for management of chronically retained foreign bodies at present.A unique case is presented of two chronically retained teaspoons in the stomach that failed endoscopic retrieval and required laparoscopic surgery.Post operatively,the patient did well with no complications.A large foreign body that is not amenable to endoscopic intervention will benefit from surgery.If expertise is available,laparoscopic intervention is a safe and feasible option to remove large foreign bodies from the stomach that is not amenable to endoscopic retrieval.

Aorto-oesophageal fistula after corrosive ingestion:A case report

BACKGROUND Aorto-oesophageal fistula(AOF)are uncommon and exceedingly rare after corrosive ingestion.The authors report a case of AOF after corrosive ingestion that survived.A comprehensive literature review was performed to identify all cases of AOF after corrosive ingestion to determine the incidence of this condition,how it is best managed and what the outcomes are.CASE SUMMARY A previously healthy 30-year-old male,presented with a corrosive oesophageal injury after drain cleaner ingestion.He did not require acute surgical resection,but developed long-segment oesophageal stricturing,which was initially managed with cautious dilatation and later stenting.An AOF was suspected at endoscopy performed two months after the ingestion,when the patient represented with massive upper gastrointestinal bleeding.The fistula was confirmed on computerised tomographic angiography.The initial bleeding at endoscopy was temporised by oesophageal stenting;a second stent was placed when bleeding recurred later the same day.The stenting successfully achieved temporary bleeding control,but resulted in sudden respiratory distress,which was found to be due to left main bronchus compression caused by the overlapping oesophageal stents.Definitive bleeding control was achieved by endovascular aortic stent-grafting.A retrosternal gastroplasty was subsequently performed to achieve gastrointestinal diversion to reduce the risk of stent-graft sepsis.He was subsequently successfully discharged and remains well one year post injury.CONCLUSION AOF after corrosive ingestion is exceedingly rare,with a very high mortality.Most occur weeks to months after the initial corrosive ingestion.Conservative management is ill-advised.

Ingestion and In <i>Vivo</i>Digestibility of a Concentrated Granulated Feed Containing Seeds of <i>Moringa oleifera</i>Associated with <i>Pennisetum purpureum</i>in Guinea Pigs

In order to contribute to the improvement of guinea pig nutrition through the use of unconventional vegetable protein sources (Moringa oleifera seeds), experimental trials were carried out at the Animal Production and Nutrition Research Unit (URPRONAN) of the University of Dschang in April 2018. Moringa oleifera seeds from North Cameroon were divided into three treatments: the first consisted of whole Moringa oleifera seeds (MO-whole), the second of Moringa oleifera seeds soaked in cold water for 24 hours (MO-water) and the third of peeled Moringa oleifera seeds (MO-peeled). The seeds belonging to these three treatments were analyzed for the determination of the chemical composition before being incorporated into the different concentrates. Each concentrate was then granulated and combined with Pennisetum purpureum to make up the different rations. 40 English Guinea pigs with an average weight of 350 ± 50 g were used to evaluate the ingestion and digestibility of each ration. During the digestibility test which lasted 17 days (10 days of adaptation and 07 days of data collection), each ration was repeated on 10 Guinea pigs. The main results showed that the total tannin and phenol contents decreased significantly (p < 0.05) in M. oleifera seeds soaked for 24 hours (8.2% DM;2884 mg/100gMS) and pulped (13.6% DM;3156 mg/100gMS). The intake of crude cellulose (10.26 gMS/d) and crude protein (3.21 gMS/d) in rations containing whole M. oleifera seeds was significantly (p < 0.05) lower than in other rations. Similarly, crude protein digestibility (77.04%) of rations containing whole M. oleifera seeds was significantly (p < 0.05) lower than other rations. This study shows that Moringa oleifera seeds soaked for 24 hours or pulped can be used in guinea pig feed as an alternative source of protein.

A Case and Review of Death Associated with Ingestion of Detergent

We experienced an autopsy case of a death associated with ingestion of liquid detergent. The deceased was an 82-year-old woman who was found dead in her bed room. Autopsy revealed corrosive changes of the mucosal surfaces of the lung. The larynx, trachea and stomach contained mucoid matter with abundant froth. Toxicological investigations detected polyethylene glycol in the bronchus, blood and gastric contents using headspace-gas chromatography/mass spectrometry. Surfactants generally have low toxicity but can cause damage to the mucous membrane of the respiratory tract. We report here an autopsy case of death by suicidal ingestion of liquid detergent with special regard to the histochemical findings of the case study.

Isolated Full Thickness Jejunal Necrosis Following Sulphuric Acid Cocktail Ingestion – A Clinical Case Report—Isolated Corrosive Jejunal Necrosis

Isolated involvement of the lower gastrointestinal tract with relative sparing of the oesophagus and the stomach is extremely rare following corrosive agent ingestion. We report a case of isolated full thickness jejunal necrosis following sulphuric acid cocktail ingestion. A 42 year old man presented with history of consuming 200ml of sulphuric acid mixed with alcohol, with suicidal intent. On exploration there were multiple, full thickness necrotic areas in the proximal jejunum with minimal congestion of the oesophagus, stomach and duodenum. Inversion of the jejunal necrotic areas with feeding jejunostomy was carried out. However postoperatively patient developed progressive pulmonary insufficiency with features of sepsis and expired on the nineteenth day following a bout of massive haematemesis. Corrosive agents when taken in considerable amount mixed with other fluids can lead to full thickness small bowel necrosis with relative sparing of the proximal gastrointestinal tract.

Accidental Ingestion of Petroleum in Children at the University Hospital of Brazzaville

Introduction: Petroleum ingestion is a health problem in Africa and can be responsible for significant mortality. Objectives: Improving the management of accidental petroleum ingestion in children, describe the socio-demographic characteristics, clinical, therapeutic and evolutionary profile of children hospitalized for accidental ingestion of petroleum and identify the factors associated with the occurrence of petroleum pneumopathy. Patients and Methods: We conducted a cross-sectional analytical study with retrospective collection from January 2016 to December 2015, i.e. in 24 months in the Pediatric Intensive Care and Infant Pediatrics departments at the University Hospital of Brazzaville. We included children who accidentally ingested petroleum. The variables studied were epidemiological, clinical, therapeutic, radiological and evolutionary. The statistical tests used were Pearson’s Chi2 and Odds ratio. The materiality threshold was set at 5%. Results: Out of 8013 children hospitalized, 78 (1%) had accidentally ingested petroleum, including 49 (62.8%) boys and 29 (37.3%) girls with an average age of 20 months. They were between 13 and 30 months old n = 44 (56.4%). The mothers were between 25 and 35 years old n = 49 (62.8%), no profession n = 31 (39.7%) and secondary education level n = 49 (62.8%). The mode of ingestion was self-ingestion (75.6%). The place of occurrence was the family home (92.3%). The motive of admission was breathlessness n = 59 (75.6%). An auscultation anomaly was noted n = 46 (59%), a pneumopathy n = 43 (55.1%). The treatment consisted of oxygen therapy n = 51 (65.4%), antibiotic therapy n = 70 (89.7%). The factors associated with the occurrence of a pneumopathy were: maneuvers performed and the existence of a cough. The lethality was 3.8%. Conclusion: The high frequency of accidental petroleum ingestions in children with an outcome often marked by pulmonary complications and the related case fatality rate requires primary preventive measures that rely on information, communication for behavior change with an emphasis on careful storage of toxic products and to refrain from harmful actions when faced with petroleum intoxication.

Filtration rate and ingestion rate of Antarctic krill measured in vitro and in situ

During the summer cruise of R/V JIDI in 1992/1993 filtration rate and ingestion rate of Antarctic krill Euphausta superba Dana were measured by constant volume incubation, flow-through incubation and gut fluorescence method in the southern part of the Scotia Sea and in the Prydz Bay region. The mean filtration rate obtained by different methods ranged form 189. 8 to 459. 6 ml/h for sub-adult (60.6～205. 4 mg dry weight), and 253. 6～902. 1ml/h for adult (166. 8～598. 7 mg dry weight). No significant methedological effect was found on measurement of filtration rate if suitable experimental conditions were used with special respect to animal density and vessel volume. Within the range of food concentration (0. 44～3. 05μg chl-α/l) of our experiments. The ingestion rate increased with the increasing of food concentration, while the filtration rate didn't increase. The ingestion rate obtained by gut fluorescence method had no correlation with ambient chlorophyll α concentration.