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2014, vol. 39, iss. 2, pp. 90-93
Corrosive poisoning: Case report
aDom zdravlja Jagodina, Služba hitne medicinske pomoći
bClinical Centre Niš, Clinic of Endocrinology, Diabetes and Metabolic Disorders

emailmilan_mdj@hotmail.com
Keywords: corrosive; intoxication; measures
Abstract
Introduction: Acids are corrosive compounds which extract water from the tissues, coagulate the proteins to form the acid of albumin and convert hemoglobin to the acid hematin. On the world map of toxicology, Serbia is considered to be the country with high percentage of caustic intoxication. In developed countries corrosive poisoning is extremely rare due to unavailability of the products and forbidden free sale. Aim: To highlight the importance, size and frequency of corrosive poisoning, to show fatal acetic acid ingestion and the model of pre-hospital and hospital care for acutely poisoned with corrosives, as well as suggest measures to reduce these intoxications. Material and methods: Case history was used of the Clinic for Endocrinology, Diabetes and Metabolism Disorders, Toxicology Department, Clinical Centre Niš and a forensic autopsy report of the Institute for Forensic Medicine Niš. Case report: The circumstances of poisoning: A female patient drank deliberately about 200ml of acetic acid at about 9 p.m. on 21st February 2014 with suicidal intentions due to disagreements in the family. She was brought conscious in Admission and Triage Department of the hospital in Vranje at 9:49 p.m., where she gave the information on the intentional self-intoxication. She vomited, a urinary catheter was placed and haematuria in the urine was obtained. It was the first suicide attempt, not treated psychiatrically so far. She was transported to the Clinical Centre Niš at 0:35 a.m. on 22nd February 2014. She was examined by an ENT specialist and submitted to urgent EGDS (esophagogastroduodenoscopy). Objective status: severe patient with PSS (poisoning severity score) 4. Hyperaemic skin around the lips, with burns, oral cavity hyperaemic, edematous. Abdomen: painfully sensitive to palpation diffusely, urine bag with 1500ml of the haematurian urine. Lab: Gly 39.9; Urea 10.9-12.6; Crea 133.0-167.3; Amy 606.7; Acid-base status pH 7.19; BE -18.9, HCO3 10.3. Urgent EGDS: In the esophagus, stomach, duodenal bulb and postbulbar duodenum, mucous membranes are livid whitish with hyperaemic parts. Conclusion: The female patient was hospitalized after intentional intoxication with corrosive substances (acetic acid) in the severely bad general condition. During hospitalization tracheotomy was performed due to respiratory failure and developed anuria leading to acute renal failure. Despite all resuscitation measures there was a lethal outcome at 1:40 a.m. on 22nd February 2014. Macroscopic autopsy findings: the tongue is flubby, covered with dirty-brownish deposits that are easily removed. Moderate amount of dirty-dark-brownish-liquid content is present in the esophagus, its mucous membranes darkly painted over the entire surface, thin, lacking its upper layer. About 100 cc of brown-greenishmushy content present in the stomach. Its mucosal folds deleted, swollen, peeling of the mucous membranes, almost completely darkly painted over, finely granular in places. Conclusion: Emphasis should be placed on preventive measures. The management of the intoxicated patient distinguishes pre-hospital and hospital measures. Possible complications include an esophageal stricture, stenosis of the pylorus and the esophagus, or gastric cancer. Highly concentrated acetic acid is still frequently ingested with a high mortality rate. Patients with higher grades of gastrointestinal injury, pneumonia, renal injury and higher amount of acid ingested should be more carefully monitored as they are more susceptible to develop fatal consequences.
References
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Brusin, K., Krayeva, Y. Highly Concentrated Acetic Acid Poisoning: 400 Cases reviewed. Dostupno na: http://apjmt.mums.ac.ir/article_19_0.html
Ilić, S. Trovanje kiselinama. Dostupno na: http://www.stetoskop.info/Trovanje-kiselinama-1370-c9-content.htm?b8
Jović-Stošić, J. (2006) Trovanja korozivnim tečnostima - dijagnostičke i terapijske nedoumice. Vojnosanitetski pregled, vol. 63, br. 6, str. 593-599
 

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article language: Serbian
document type: Case Report
DOI: 10.5937/tmg1402090D
published in SCIndeks: 15/05/2015

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