CONSEQUENCES OF CAUSTIC INGESTIONS IN CHILDREN

A retrospective analysis of 98 patients, less than 15 years of age, tr eated for caustic ingestion during 1976-1990 was performed to evaluate the modern consequences of caustic ingestion in children and to set i ndications for esophagoscopies and radiographic and laboratory examina tions. Dishwasher detergents were ingested by 56 children. There were no lye ingestions, since lye has not been freely available in Finland since 1969. Household acetic acid (vinegar) was the most commonly (12/ 23) ingested acid. Primary esophagoscopy was performed in 79 of the 98 cases (80.6%). Esophageal burns were found in 20 patients. Acids caus ed burns more often than alkalies (9/23 (39.1%) versus 11/75 (14.7%); p = 0.011; 95% confidence intervals (CI) for the difference 5.6-43.3%) and acid burns more often developed into scars (7.4% versus 4%; p = 0 .029; 95% CI for the difference 1.4-25.4%). The only esophageal strict ure developed after ingestion of a Clinitest tablet. The mean time for hospitalization as a result of acid ingestion was significantly longe r than after alkaline ingestion (3.2 (SD 3.5) days, n = 23 versus 1.5( 1.6) days, n = 75; p < 0.05; 95% CI for the difference 0.7-2.8 days). Prolonged drooling and dysphagia (12-24h) predicted esophageal scar fo rmation with 100% sensitivity and 90.1% specificity, but signs and sym ptoms did not predict esophageal burns after primary esophagoscopy, Ra diographic examinations and leukocyte counts were of no value in predi cting esophageal burns and scars. The panorama of caustic ingestion ap pears to have changed, probably due in part to the law banning sale of lye products since 1969. This type of law should be encouraged elsewh ere. Acids cause even more caustic burns than alkalies. Vinegar should be regarded as a potent caustic substance and distributed in baby-saf e bottles with appropriate information on its caustic nature. As sever e esophageal lesions after accidental ingestion of caustic substances are now rare in children, primary esophagoscopies and hospitalization of patients are not indicated routinely. The decision on esophagoscopy can be made on the basis of drooling and dysphagia during follow-up.