REBEL Core Cast 103.0 – Caustic Ingestions
Highlights
- Pediatric presentations of caustic ingestions
Key takeaways:
- Caustics are xenobiotics that cause tissue damage, both functionally and histologically, upon contact.
- Other things are also caustic in nature, and can include acids and bases.
Transcript:
Speaker 1
All right. So the last time we had, John, we were talking about alcoholic ketoacidosis. This is a core presentation, EM, that I don't know, I see at least once a week. Today we're going to get into something that's a little bit less common, but important for us to understand basic management, which is caustic ingestions. And today, because we like to give our listeners everything we possibly can, we've got a little bit of a two-for-one deal. We not only have you, but we also have your wife, Elise Perelman, who is a PEM superstar at Cohen's Children's Medical Center. She's going to join us to talk a little bit about the pediatric presentations. Let's start, though, with some of the basics. When we talk about caustics, what substances are considered in that group and what are the common exposures that we're going to see?
Speaker 2
Caustics are xenobiotics that cause tissue damage, both functionally and histologically, upon contact. Now, I think it's natural to think of caustics as only acids or bases, but it's important to remember that other things are caustic in nature. (Time 0:00:18)
- Pediatric presentations of caustic ingestions
Key takeaways:
- Caustics are xenobiotics that cause tissue damage, both functionally and histologically, upon contact.
- Other things are also caustic in nature, including desiccants, things that dry tissue, and vesicants, things that blister tissue.
Transcript:
Speaker 1
All right. So the last time we had, John, we were talking about alcoholic ketoacidosis. This is a core presentation, EM, that I don't know, I see at least once a week. Today we're going to get into something that's a little bit less common, but important for us to understand basic management, which is caustic ingestions. And today, because we like to give our listeners everything we possibly can, we've got a little bit of a two-for-one deal. We not only have you, but we also have your wife, Elise Perelman, who is a PEM superstar at Cohen's Children's Medical Center. She's going to join us to talk a little bit about the pediatric presentations. Let's start, though, with some of the basics. When we talk about caustics, what substances are considered in that group and what are the common exposures that we're going to see?
Speaker 2
Caustics are xenobiotics that cause tissue damage, both functionally and histologically, upon contact. Now, I think it's natural to think of caustics as only acids or bases, but it's important to remember that other things are caustic in nature. Desiccants, things that dry tissue and vesicants, things that blister tissue. (Time 0:00:18)
- Common Pediatric Ingestions: What to Look For
Key takeaways:
- Pediatric populations are more likely to explore their surroundings by ingesting things,.
- Ingestions in pediatric populations are usually exploratory in nature, meaning they are not usually harmful.
Transcript:
Speaker 1
That's interesting because I think we don't really think about that side of it, or like if we get them through this initial window of time through the ICU, they're going to be okay, but that is something down the line to think about. Let's talk about some of the presentations, knowing some of the household caustics that people are going to get into. What are the common presentations that we're going to see in the emergency department?
Speaker 2
And I think it's super important to break it down in between pediatrics and adults. Let's start with pediatrics, and with that, I'll let my wife do most of the talking.
Speaker 3
So it is important to recognize that in pediatric populations, most ingestions are exploratory in nature, meaning kids are silly. They like putting stuff in their mouths, licking, tasting, and trying various things, especially ones that look like fun-colored drinks or treats like liquid detergent pods. This can obviously lead to serious harm depending on the type and the amount of exposure, which luckily is usually minimal. When it comes to their presentation, they may be asymptomatic, and in fact, look great, (Time 0:01:54)
- The Danger of Ingesting Cleaning Supplies
Key takeaways:
- In pediatric patients, they are often afraid of the hospital and the doctors, which can make it difficult to get them to cooperate.
- It is important to take a step back and calm the patient down before trying to talk to them.
- In cases of ingestions, it is important to look for any signs of acute illness, such as swelling, drooling, and difficulty breathing.
Transcript:
Speaker 3
Part of the trouble of examining a pediatric patient, especially the younger ones, is that they're afraid of you. So they're already afraid of the situation. They're afraid to be in the hospital and you walk in the room, you're a stranger, they've never seen you before. So what I like to do is I actually like to take a step out of the room, have them calm down with their family or parent. And if you have child life, that's wonderful and kind of see what they're doing but you're not there.
Speaker 1
All right, Sanjay, let's bring it back from the little ones to the big ones. Give us the adult presentations.
Speaker 2
In the adult population, you could risk stratify it by intent. In toxicology, you're always worried about patients who intentionally ingested something in an attempt for self-harm, with the thinking being that they ingested a large volume and they're trying to hurt themselves as a result. In contrast, the vast majority of our consultations are unintentional ingestions. For whatever reason, people have a dangerous tendency to place cleaning supplies in water bottles or often other containers and as a result unintentionally take a sip or a gulp. How many acute manifestations after a costly ingestions include or a pharyngeal swelling, drooling and emphasis? For those patients that presented a delayed fashion, esophageal perforation or bowel perforation may lead to peritonitis and sepsis, leading me ultimately in suit with the vessel erodes. (Time 0:03:57)