sodium-hypochlorite and Burns--Chemical

The literature concerning the etiology, symptomatology and management of complications during root canal irrigation is reviewed. Clinical symptoms are discussed, as well as preventive and therapeutic considerations.

Topics: Burns, Chemical; Cornea; Extravasation of Diagnostic and Therapeutic Materials; Eye Burns; Facial Pain; Humans; Periapical Tissue; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Therapeutic Irrigation

Sodium hypochlorite (NaOCl) in various concentrations is the most widely used endodontic irrigant, but it can be an irritant to vital tissues. There are several reports about the complications of irrigation with NaOCl during root canal therapy. Most of the complications are the result of accidental extrusion of the solution from the apical foramen or accessory canals or perforations into the periapical area. This article is a review and comparison of all reported NaOCl accidents in the literature.

Topics: Accident Prevention; Burns, Chemical; Extravasation of Diagnostic and Therapeutic Materials; Humans; Root Canal Irrigants; Sodium Hypochlorite

LITERATURE REVIEW AND CASE REPORTS: The literature concerning the aetiology, symptomatology and therapy of complications during root canal irrigation is reviewed. Three cases of inadvertent injection of sodium hypochlorite and hydrogen peroxide beyond the root apex are presented. Clinical symptoms are discussed, as well as preventive and therapeutic considerations.

Topics: Animals; Burns, Chemical; Extravasation of Diagnostic and Therapeutic Materials; Eye Burns; Female; Humans; Hydrogen Peroxide; Hypersensitivity; Male; Middle Aged; Oral Hemorrhage; Root Canal Irrigants; Sodium Hypochlorite; Subcutaneous Emphysema

The effects of an inadvertent injection of sodium hypochlorite into the cheek during irrigation of the right maxillary central incisor root canal are reported. The patient suffered from severe pain, edema, and necrosis of subcutaneous tissues and mucosa. Surgical intervention was necessary to contain the destructive process which extended from the upper lip to the right eye. The histopathological examination demonstrated the high cytotoxicity of sodium hypochlorite on vital tissue.

Topics: Adult; Burns, Chemical; Cheek; Edema; Facial Pain; Female; Humans; Iatrogenic Disease; Root Canal Irrigants; Sodium Hypochlorite

Alkaline ingestion is a potentially life-threatening problem that may confront the emergency physician. It is similar to many other toxins in that children and those who attempt suicide are its most common victims; however, implications in terms of initial stabilization and definitive care are quite distinct. Mucosal exposure to lye results in a quick, deep liquefactive necrosis. Consequently, blind nasotracheal intubation may result in the perforation of damaged tissues in the pharynx and trachea. For similar reasons, the blind passage of a nasogastric tube is contraindicated. The use of diluents in this setting is controversial. If a diluent is used, water and milk are considered the liquids of choice. They may be used to irrigate oropharyngeal burns, but are contraindicated in the face of respiratory compromise, shock, liquid lye ingestion, and perforation of the esophagus or stomach. Cathartics and charcoal are not used after alkaline ingestion. Cathartics, however, are used in miniature alkaline battery ingestions to diminish bowel transit time. Esophagoscopy should be done within 12 to 24 hours after ingestion to directly observe the extent of damage. This procedure should be stopped at the first sign of injury to protect against iatrogenic esophageal perforation. Steroids should be started for circumferential esophageal burns and in those patients with significant injury who are unable to undergo esophagoscopy. IV antibiotics are administered for gastrointestinal perforation and may be used concomitantly with steroids. Miniature alkaline batteries lodged in the esophagus must be removed immediately. The available modalities include fluoroscopy-directed Foley catheter removal, endoscopy, and surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Burns, Chemical; Caustics; Charcoal; Child; Child, Preschool; Emergencies; Emetics; Endoscopy; Esophageal Stenosis; Esophagoscopy; First Aid; Gastric Mucosa; Gastroscopy; Household Products; Humans; Infant; Intestinal Mucosa; Lye; Methylprednisolone; Middle Aged; Sodium Hypochlorite; Therapeutic Irrigation

Topics: Accidents, Home; Acetates; Adrenal Cortex Hormones; Alkalies; Burns, Chemical; Carbonates; Caustics; Dilatation; Esophagoscopy; Esophagus; Eye Burns; Humans; Hydroxides; Peroxides; Potassium; Prednisolone; Sodium; Sodium Hydroxide; Sodium Hypochlorite; Therapeutic Irrigation

To evaluate the demographic characteristics, endoscopy results, emerging complications and the final status of caustic intake cases admitted to our emergency department.. This study is a retrospective one concerning patients admitted to our emergency department due to caustic ingestion. Demographic characteristics of the patients, complaints while applying to the hospital, physical examination findings, the purpose of caustic intake, the characteristics of corrosive substance taken, times of endoscopy following admission to the emergency department, follow-up times in the emergency department, endoscopic staging and outcome. The data were analyzed through IBM SPSS Statistics Base 22.0 package program.. Seventy four patients participated in the study. 83.8% of corrosive substance intake cases were accidental and 16.2% cases were suicidal intention. While 60.8% of the corrosive substances taken had alkaline property, 36.5% were acidic and 2.7% were found to be unknown substances. 50% of the corrosive substance intakes were sodium hypochlorite. It was seen that endoscopy was performed in 59 patients who accepted endoscopy within an average of 244.07 min after admission to the emergency department. While no damage could be seen in 55.9% of patients following endoscopy, the most common injury was Grade 1 (35.6%).. Corrosive substance intake is a rare but potentially devastating poisoning with high morbidity and mortality. Mucosal injury begins within minutes following corrosive intake. Therefore, early endoscopy is helpful in assessing the degree of injury and early discharge from hospital.

Topics: Accidents; Adolescent; Adult; Burns, Chemical; Caustics; Endoscopy; Female; Humans; Male; Middle Aged; Retrospective Studies; Sodium Hypochlorite; Young Adult

Endoscopy is generally speculated to be unnecessary in sodium hypochlorite (NaClO) ingestions; however, a significant number of endoscopic evaluations are still being performed when this chemical is ingested. Therefore, the aim of the current study was to compare the outcome and endoscopic findings between patients who had ingested household NaClO and those who had ingested other types of corrosives. This retrospective cohort study enrolled 137 patients with a history of corrosive substance ingestion admitted to a tertiary hospital. Data were extracted from hospital records, and interviews were performed on follow-up. Demographic characteristics, endoscopic findings, and patient outcome were compared between those who had ingested household NaClO and those who ingested other corrosives (NaClO and control cohorts, respectively). Most patients (73%) had attempted suicide. Dysphonia (P ≤ .001), dysphagia (P = .04), and mouth burns (P = .047) were significantly different between the NaClO and control cohorts. Furthermore, patients who had dysphonia, dysphagia, skin burns, drooling, hematemesis, retrosternal pain, and abnormal abdominal examination were prone to death or severe complications. None of the NaClO cohort patients had severe endoscopic complications. All patients in the NaClO cohort survived without any sequelae (Odds Ratio (OR) [95% Confidence Interval (CI)] = 0.87 [0.80-0.94]) while 6 and 5 patients died and developed severe complications in the control cohort, respectively. Studies on endoscopic evaluations in patients who ingested household NaClO are scarce. Our results show that if there are no major clinical manifestations, urgent endoscopic evaluations are unnecessary in such patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Burns, Chemical; Caustics; Endoscopy, Gastrointestinal; Female; Humans; Male; Middle Aged; Retrospective Studies; Sodium Hypochlorite; Suicide, Attempted

To describe the management and successful outcome of a late-recognition partial thickness bleach burn to the face and corneas of a dog.. A 1-year-old male neutered Fox Terrier mix breed dog was evaluated for sloughing facial epithelium 5 days after coming into contact with an 8.25% household bleach cleaning solution. Severe erythema, edema, and crusting were noted around the muzzle and margins of both eyes, with moderate to severe alopecia in these areas. A partially detached, partial thickness eschar was present on the muzzle, while a firmly attached eschar was present in the region of both frontal sinuses. These injuries were consistent with a focal, superficial, and partial thickness chemical burn. Multiple ocular abnormalities, the most concerning of which was corneal ulceration, were also present. The patient's wounds were managed conservatively with limited surgical debridement of the affected epithelium 11 and 22 days after the initial exposure. Topical ocular medications, corneal debridement, and a superficial keratectomy were also used. All lesions resolved completely by 84 days postexposure, with no residual effects on the patient's quality of life.. Chemical burns caused by contact with alkaline agents such as bleach (sodium hypochlorite) result in extensive necrosis of the skin and underlying structures. This is the first report of management alkaline facial burns in a dog. If inadequate or delayed hydrotherapy following exposure has resulted in superficial partial thickness burns, conservative management can be successful when traditional treatments, especially bandaging, are not feasible.

Topics: Animals; Anti-Infective Agents; Burns, Chemical; Debridement; Dog Diseases; Dogs; Humans; Male; Sodium Hypochlorite; Wound Healing

In chronic wounds, especially burn scars, malignant tumors can arise. However, it is rare for a subacute burn injury to change to a malignant lesion within one month. Moreover, a case of squamous cell carcinoma arising from HeNe laser therapy after a chemical burn has never been reported.. In this report, we examine a rare case of squamous cell carcinoma arising from HeNe laser therapy after a chemical burn. Because pathologic investigations were made from the first operation, both early detection of the squamous cell carcinoma and consideration of the HeNe laser therapy as a risk factor for the skin cancer were possible. The cancer was completely removed and reconstruction of the defect was successfully achieved in a timely manner.. Although there has as yet been no reported case of squamous cell carcinoma induced by laser therapy, it is important for clinicians to recognize both the possibility of laser-induced cancer and the rapid change of cancer, so they can provide appropriate and timely treatment.

Topics: Burns, Chemical; Carcinoma, Squamous Cell; Female; Humans; Laser Therapy; Middle Aged; Prognosis; Skin Neoplasms; Sodium Hypochlorite; Wound Healing

This study describes a case of eye burn induced by sodium hypochlorite used as an irrigant during root canal preparation.. A 24-year-old female endodontist was using an operating microscope during root canal treatment, and as the root canal was irrigated, the pressure cannula burst and the irrigant (3.5% sodium hypochlorite) came into direct contact with her left eye. She immediately sought ophthalmologic emergency care for pain, redness of the cornea, burning sensation, photophobia, intraocular pressure, and blurred vision. The initial treatment consisted of washing the eye with saline solution and administering analgesic and anti-inflammatory (steroid) medications. One day after the accident, a topical demulcent and hydroxypropyl medication were applied to the eyeball (conjunctiva), the eye was bandaged for 24 hours, and rest was prescribed for 7 days. Eight days later, a corneal ulcer was diagnosed, and antibiotic and anti-inflammatory (steroid) medications were used.. Vision was restored without any sequelae 4 weeks after the accident. The endodontist was instructed to apply control medication (Lagricel; Sophia SA, Caracas, Venezuela) for 3 months and to return for ophthalmologic follow-up every 6 months.. Sodium hypochlorite is an effective antibacterial irrigant indicated for the treatment of root canal infections. The tissue cytotoxicity highlights the need to inform the patient of the risk factors of accidents and enhance care with individual protection equipment for the patient and the professional during clinical procedures.

Topics: Accidents, Occupational; Analgesics, Non-Narcotic; Anti-Bacterial Agents; Anti-Inflammatory Agents; Burns, Chemical; Corneal Ulcer; Cyclopentolate; Dentists; Eye Burns; Female; Fluoroquinolones; Follow-Up Studies; Humans; Ibuprofen; Loteprednol Etabonate; Microsurgery; Moxifloxacin; Mydriatics; Occupational Diseases; Prednisolone; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Therapeutic Irrigation; Young Adult

Sodium hypochlorite (bleach) is advocated as an irrigant for use in endodontic therapy for its bacteriocidal and tissue dissolving properties. Extrusion of hypochlorite into the surrounding soft and hard tissues, however, can lead to severe complications, as illustrated in our four case reports. This article considers the risk benefit ratio of the different materials available and advises dental practitioners to ensure patients are aware of the potential risks of the materials used when seeking informed consent. It also aims to provide some guidance on prevention, identification and management of incidents.

Topics: Adult; Burns, Chemical; Extravasation of Diagnostic and Therapeutic Materials; Facial Nerve Injuries; Female; Humans; Middle Aged; Necrosis; Oral Ulcer; Root Canal Irrigants; Sodium Hypochlorite; Trigeminal Nerve Injuries

The authors present a series of 6 deaths due to the uncommon cause of chemical burns. Of the 6 deaths due to chemical burns, 4 deaths were due to ingestion of a chemical, 1 death was caused by chemical burns of the skin, and 1 death resulted from rectal insufflation of a chemical. Seven additional cases where chemical burns may have been a contributing factor to the death or an incidental finding are also presented. Four cases are related to an incident involving chemical exposure during an industrial explosion. Three cases involve motor fuel burns of the skin. Two cases concern a plane crash incident, and 1 case involved a vehicular collision. Cases are derived from the records of the Dallas County Medical Examiner's Office and those of the authors' consultation practices. Each of the cases is presented, followed by a discussion of the various mechanisms of chemical injury.

Topics: Accidents; Administration, Inhalation; Administration, Rectal; Adult; Burns, Chemical; Caustics; Disinfectants; Explosions; Female; Fibrosis; Forensic Pathology; Gastrointestinal Tract; Humans; Infant; Lye; Male; Mercuric Chloride; Middle Aged; Phosphoric Acids; Respiratory Aspiration; Respiratory System; Sepsis; Sodium Hypochlorite; Suicide

Topics: Airway Obstruction; Burns, Chemical; Edema; Epiglottis; Esophagus; Humans; Hypopharynx; Sodium Hypochlorite; Stomach; Suicide, Attempted

The aim of the study was to determine whether early esophagoscopy is really necessary for the patients who have ingested a corrosive agent. Patients who were followed up with the diagnosis of corrosive ingestion in our clinic between the years 1998 and 2008 were studied retrospectively. The data were collected through the medical records of the patients and from interviews with them. The analyzed parameters included age, gender, the nature and the amount of the ingested agent, whether the event was accidental or suicidal, diagnostic tools, treatment and the results of the treatment, and long-term follow up. Over a 10-year period, a total of 124 cases of corrosive ingestion cases were determined. Of these, 64 (51.6%) were male and 60 (48.4%) were female. The mean age was 38 +/- 17.5 years. The most commonly ingested corrosive agents were sodium hypochlorite in 50 (40.3%) patients and hydrochloric acid in 33 (26.6%) patients. The mean admission time for the emergency department after ingestion of the corrosive agent was 2.5 +/- 3.7 hours. Ingestion was accidental in 82% of the patients and as a result of a suicide attempt in 18%. The amount of ingested corrosive agent in the suicidal group (190 +/- 208.3 mL) was higher than that of accidental group (66 +/- 58.3 mL) (P= 0.012). Nine patients underwent esophagoscopy, six of which were performed in other clinical centers. Only three (2.4%) patients experienced esophageal stricture, which were treated with repeated dilatations. In the long-term follow up, we could get in touch with only 63 patients and none of them had complications due to corrosive ingestion. The follow-up period ranged from 1 to 120 months (median 45 +/- 29.2 months). Based on our study, early esophagoscopy appears to be unnecessary in adult patients who ingested the corrosive agent accidentally. A larger prospective study is needed to answer the question.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Burns, Chemical; Caustics; Esophageal Diseases; Esophageal Stenosis; Esophagoscopy; Female; Humans; Hydrochloric Acid; Male; Middle Aged; Retrospective Studies; Sodium Hypochlorite; Unnecessary Procedures; Young Adult

Sodium hypochlorite is often used as an irrigation solution during routine endodontic treatment. Before recementation of a post-retained crown on the upper left lateral incisor, the root canal was irrigated with sodium hypochlorite. There was no root filling in the root canal, and the apex was open after an earlier apicoectomy. Sudden pain with swelling of the left face side occurred during root canal rinsing. Three years later, a paraesthesia still remained in the affected region and a paralysis of some mimic muscles in this region was observed. There were no signs of improvement.

Topics: Apicoectomy; Burns, Chemical; Extravasation of Diagnostic and Therapeutic Materials; Facial Muscles; Facial Nerve; Facial Paralysis; Female; Humans; Hypesthesia; Middle Aged; Root Canal Irrigants; Sodium Hypochlorite; Trigeminal Nerve

Sodium hypochlorite (NaOCl) is a well documented and widely accepted intracanal irrigant used to disinfect the pulp space in endodontic therapy. NaOCl can be an extremely cytotoxic material; therefore, care must be taken with its use. The authors present a case of periradicular extravasation of NaOCl with sequelae of pain, swelling, ecchymosis and parasthesia consistent with a chemical burn. The patient was treated with a nonsurgical medical management approach. She experienced a complete resolution of signs and symptoms, aside from a persistent residual focal parasthesia.

Topics: Bicuspid; Burns, Chemical; Ecchymosis; Edema; Extravasation of Diagnostic and Therapeutic Materials; Face; Female; Humans; Maxilla; Middle Aged; Paresthesia; Periapical Tissue; Root Canal Irrigants; Sodium Hypochlorite

The authors report on a case of postmortem washing of a body with bleach. An adult female victim was found nude in an alleyway with both hands removed in the City of Westminster, CO. Cause of death was attributed to severe blunt force trauma to the head. The victim had been dumped in the alleyway within 7 h of discovery. Evidence discovered at the crime scene and autopsy indicated that the murder and subsequent washing of the body with bleach occurred at a secondary location(s). The victim was wet to the touch, presenting a strong odor of bleach. Several "ribbon"-like burn patterns were observed on the victim's back and upper thighs. These burn marks were replicated by dowsing a deceased pig with an over-the-counter concentration of bleach.

Topics: Adult; Animals; Burns, Chemical; Disinfectants; Female; Forensic Medicine; Head Injuries, Closed; Homicide; Humans; Models, Animal; Skin; Sodium Hypochlorite; Swine

Acute irritant contact dermatitis induced by cutaneous exposure to chemicals is a common dermatologic problem in the workplace. In severe cases, irritant contact responses can result in a caustic burn. Chemical burn induced by concentrated sodium hypochlorite (the active ingredient in bleach) has been reported infrequently in the literature, with no previously reported cases of chemical burn due to an alkyl sulfate (a common surfactant in cleaning fluids). Here we describe a chemical burn in a 16-year-old girl resulting from exposure to a solution of concentrated sodium hypochlorite and alkyl sulfate applied as a sanitizer to the interior of roller skates worn at work.. The diagnosis was made on the basis of the patient's exposure history, clinical appearance, and laboratory results. On physical examination, the erythematous plaque, located at the site of chemical exposure, had intact skin lines, surrounding edema, and decreased sensitivity to touch. The peripheral white blood cell count was within normal limits and bacterial and fungal cultures from the lesion were negative.. The irritant effect of exposure to chemicals, including those that usually are not major irritants, and the possible additive effect of simultaneous exposure to different chemicals, should be considered in the differential diagnosis of acute dermatitis of unknown etiology. Moreover, increased reporting of cases of chemical-induced acute irritant contact dermatitis will help lead to crucial early and appropriate treatment.

Topics: Acute Disease; Adolescent; Anti-Infective Agents, Local; Burns, Chemical; Dermatitis, Irritant; Detergents; Diagnosis, Differential; Female; Humans; Silver Sulfadiazine; Skin; Skin Transplantation; Sodium Hypochlorite; Sulfuric Acid Esters; Therapeutic Irrigation; Wound Healing

Topics: Airway Obstruction; Anti-Bacterial Agents; Anti-Inflammatory Agents; Burns, Chemical; Decompression, Surgical; Extravasation of Diagnostic and Therapeutic Materials; Humans; Intubation, Intratracheal; Male; Middle Aged; Mouth; Root Canal Irrigants; Sodium Hypochlorite

The objective of this study was to analyze the circumstance, demographic features, clinical findings, and complications of caustic ingestion in relation to the type and amount of caustic substance.. The authors conducted a retrospective cohort study in a tertiary medical center.. The authors reviewed medical records from 1988 to 2003 of patients with a history of caustic ingestion and clinical signs of injury to the aerodigestive tract. Parameters examined included age at presentation, gender, demographic status, nature of the caustic substance ingested, amount of substance, circumstance of the event, diagnostic tools, degree of injury, and anatomic distribution of the injury, early and late complications, and requirement for ventilatory support.. A total of 50 cases of caustic ingestion were identified (age range, 5 months-71 years). A biphasic distribution of the patients was noted; half were children under 5 years old and the remainder was adults. The most common caustic agent ingested was alkaline (42%) followed by acidic (32%) and chlorine bleach (26%). The most frequent cause for ingestion was accidental (67%) as opposed to attempt suicide (33%). All cases of attempted suicide occurred in adults. Most of them reported ingestion of large amounts of caustic substance. In the pediatric group, an association between the caustic agent and ethnicity was observed. Among Jewish children, alkaline cleaning agents were the most common cause (82%). Acetic acid was the most common substance ingested by the Arab children (100%). The findings of rigid esophagoscopy in 36 patients were as follows: first-degree esophageal injury in 16 (44%), second-degree in 6 (17%), third-degree in 7 (19%), fourth-degree in 6 (17%), and one (3%) was normal. Mucosal injury to the esophagus was worse in the acidic ingestion group as compared with the alkaline substance ingestion group with marginally statistically significant difference in the median degree of injury between the three types of ingested substances (P = .054). Mucosal injury to the esophagus was worse among patients who attempted suicide as compared with accidental ingestion with a statistically significant difference in the median degree of injury between the two reasons for ingestion (P = .002).. Severity of injury from caustic ingestion damages depend on the type of ingested substance, which varies depending on ethnicity. Ingestion of caustic agents by children involves specific substances according to the season, cultural and religious festivals, and ethnicity. The majority of adult cases are intentional with more serious injuries and a higher rate of complications. In our series, ingestion of acidic substances and ingestion associated with suicide attempt had the most severe consequences.

Topics: Accidents; Acetic Acid; Acids; Adolescent; Adult; Age Factors; Aged; Alkalies; Burns, Chemical; Caustics; Child; Child, Preschool; Chlorine Compounds; Cohort Studies; Esophagus; Ethnicity; Female; Humans; Infant; Israel; Male; Middle Aged; Mucous Membrane; Retrospective Studies; Sodium Hypochlorite; Suicide, Attempted

Endodontic therapy is a routinely practised clinical procedure with few reported complications. Sodium hypochlorite is often used as an irrigant during this procedure, but severe complications may occur if this solution extravasates beyond the root apex. We present a case demonstrating some of the severe sequelae that can occur following the misuse of sodium hypochlorite during endodontic treatment of an upper lateral incisor, which also resulted in the previously unreported complication of isolated facial nerve weakness.

Topics: Adult; Anti-Inflammatory Agents; Burns, Chemical; Dexamethasone; Extravasation of Diagnostic and Therapeutic Materials; Facial Injuries; Facial Nerve Injuries; Female; Humans; Injections, Intravenous; Mouth Mucosa; Necrosis; Root Canal Irrigants; Sodium Hypochlorite

Topics: Burns, Chemical; Extravasation of Diagnostic and Therapeutic Materials; Facial Nerve Injuries; Humans; Mouth Mucosa; Root Canal Irrigants; Sodium Hypochlorite

A case of accidental skin injury caused by leakage of sodium hypochlorite solution from the rubber dam during root canal preparation is reported. After placement of a rubber dam and initiation of root canal treatment, the patient complained of a burning sensation with sodium hypochlorite irrigation. The complaints were ignored by the practitioner, and a skin rash developed on and around the patient's chin, followed by scab formation. The patient required medical treatment with topical Hamamelis virginiana extract for 2 weeks, with full recovery.

Topics: Burns, Chemical; Chin; Facial Injuries; Female; Hamamelis; Humans; Middle Aged; Phytotherapy; Plant Extracts; Root Canal Irrigants; Rubber Dams; Sodium Hypochlorite

Two patients with corrosive esophagitis caused by alkaline household agents were examined with endoscopic ultrasound using a 20-MHz probe. In the first case, endoscopic ultrasound revealed circumferentially thickened mucosa and muscularis propria, and lack of differentiation between the mucosa and submucosa. However, esophageal stricture did not develop during 3 months of follow-up, suggesting that the deep lesion may have involved a narrow section of esophagus only. In the second case, a markedly thickened mucosa was seen, resulting in no sequelae. Endoscopic ultrasound offers a more accurate evaluation of the depth of the lesions in alkaline esophagitis compared to standard endoscopy or computed tomography. Longitudinal studies are needed to identify lesions at greatest risk for progression to stricture.

Topics: Adult; Burns, Chemical; Caustics; Endosonography; Esophagitis; Esophagus; Female; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Oxidants; Sodium Hydroxide; Sodium Hypochlorite; Suicide, Attempted

Topics: Accidents, Home; Administration, Inhalation; Airway Obstruction; Bronchodilator Agents; Burns, Chemical; Caustics; Epinephrine; Female; Humans; Infant; Nebulizers and Vaporizers; Oxidants; Sodium Hypochlorite; Treatment Outcome

Caustic products are responsible for the most serious cases of poisoning, which are always emergency cases. Application of current intervention procedures has decreased both morbidity and mortality. Water-diluted bleach, the ingestion of which remains extremely frequent, is a moderate irritant rather than a caustic product. Emission of gas produced when mixing bleach with other agents can be responsible for choking gas poisoning. Anionic and nonionic detergents are mostly dangerous because of their foam-producing properties. Mercury vapours and methanol are other potentially hazardous products.

Topics: Acute Disease; Adult; Aged; Burns, Chemical; Caustics; Child; Detergents; Esophageal Stenosis; Household Products; Humans; Middle Aged; Poisoning; Sodium Hypochlorite; Stomach

Knowledge of the sequelae of caustic ingestion is of relevance to staff of the Emergency Room, Intensive Care Unit, surgical and gastroenterology services. It poses a considerable management problem and may result in life-threatening complications such as visceral perforation. This case report demonstrates an unusual and previously unreported manifestation of caustic injury.

Topics: Adult; Burns, Chemical; Diaphragm; Female; Humans; Parenteral Nutrition; Pneumothorax; Sodium Hypochlorite; Stomach

A retrospective study was done on corrosive oesophageal burns to ascertain the preventive effect of corticosteroids on stricture development. Within the last 12 years 351 children were admitted to our medical centre with a history of corrosive agent ingestion. In 235 of these the diagnosis of oesophageal burn was confirmed by means of oesophagoscopy. Children admitted within the first 48 hours received steroid, antibiotic and fluid therapy while fluid and antibiotics were given, if needed, in the rest. Forty-six of the children were lost to follow-up. The type of corrosive agent, the admission period, the degree of the burn and the stricture development were used as parameters. Stricture development was found statistically significant in late admitted patients vs. early admissions. This retrospective study suggests the effectiveness of corticosteroid treatment in preventing the stricture development.

Topics: Acetates; Adrenal Cortex Hormones; Burns, Chemical; Child; Esophageal Stenosis; Humans; Hydrochloric Acid; Nitrates; Retrospective Studies; Sodium Hydroxide; Sodium Hypochlorite; Sulfuric Acids; Time Factors

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Burns, Chemical; Child; Child, Preschool; Disinfectants; Eye Burns; Female; Humans; Infant; Male; Middle Aged; Sodium Hypochlorite

Sodium hypochlorite is used in endodontic therapy as an intracanal irrigant during hand, mechanical, and ultrasonic instrumentation of the root canal space. Regardless of the technique utilized, particular attention must be given to the appropriate and safe use of this chemical solution. A case is presented in which a 5.25% sodium hypochlorite solution was accidentally splashed in a patient's eyes during endodontic therapy. Ocular irrigation was performed immediately and continued for 10 min. The patient was promptly taken to an ophthalmologist for further treatment and follow-up. When chemical trauma of the eye by sodium hypochlorite solution is sustained, the entire surface of the affected eye(s) and the fornices must be thoroughly irrigated. This is best accomplished with a continuous stream of normal saline from a 1-I bag which is attached to an intravenous line with a 16-gauge Teflon catheter placement sleeve affixed to the distal end of the line. Arrangements must then be made for immediate evaluation, treatment, and consultation by an ophthalmologist.

Topics: Adolescent; Burns, Chemical; Eye Burns; Humans; Male; Root Canal Irrigants; Sodium Hypochlorite; Therapeutic Irrigation

The authors reviewed 125 cases of accidental ingestion of caustic substances admitted to a general pediatrics department over the last four years. L'eau de Javel (bleaching agent with sodium hypochloride) was the most frequently encountered caustic substance (89%). Esophagogastric fibroscopy was performed in 100 cases and esophageal lesions were classified according to tree grades of severity. In 46 cases, fibroscopy was normal, while severe esophagogastric lesions (grades 2 and 3) were found in 26 cases. On follow-up, six patients developed esophageal stricture, three of them after concentrated, eau de Javel ingestion. Stricture was severe in four cases, and required colonoplasty of the esophagus; it was limited in two cases and required endoscopic dilatation only. The authors emphasize the frequency and the severity of lesions caused by chloride bleach (eau de Javel) and recommend that fibroscopy be carried out in all children following ingestion of any caustic substance, even in the absence of oropharyngeal burns.

Topics: Burns, Chemical; Caustics; Child; Child, Preschool; Endoscopy, Digestive System; Esophagus; Female; Humans; Infant; Male; Sodium Hypochlorite; Stomach; Tunisia

In this paper we describe the use of circular myotomies to approximate the oesophageal ends resulting from resection of an oesophageal stricture due to ingestion of domestic bleach. This procedure has spared the child from major oesophageal surgery with its known morbidity. This is the second case described using this method from this institute.

Topics: Barium Sulfate; Burns, Chemical; Child, Preschool; Esophageal Stenosis; Esophagoplasty; Female; Follow-Up Studies; Humans; Postoperative Complications; Radiography; Sodium Hypochlorite

A tank truck containing bulk pool chlorinating solution overturned. A man was trapped beneath the truck, and a ruptured seam in the tank released a continuous flow of sodium hypochlorite over him. He survived for 10 min as the caustic solution extensively eroded soft tissue exposed to the chemical flow.

Topics: Accidents, Traffic; Adult; Burns, Chemical; Cause of Death; Humans; Leg Injuries; Male; Sodium Hypochlorite

Controversial therapeutic issues in patients with caustic ingestions concern the reliability of symptoms and signs in predicting esophageal injury, the appropriate use of endoscopy in evaluating esophageal damage, and the use of steroids in preventing late strictures. The conclusions of this review are: The majority of pediatric caustic ingestions involve a "lick and taste" whereas adolescents and adults often ingest substantial quantities. Oral burns and dysphagia are sensitive predictors of esophageal injury; however, esophageal injury may occur in the absence of the findings. Household bleach and nonphosphate detergents represent a low risk of injury whereas button batteries greater than 20 mm in diameter and Clinitest tablets represent high risk. Endoscopy should be an elective rather than emergency procedure and should be undertaken in all symptomatic patients, and in asymptomatic patients when history indicates substantial ingestion. Steroid therapy should be considered only for patients who have deep or circumferential esophageal burns.

Topics: Acids; Adolescent; Adult; Alkalies; Animals; Burns, Chemical; Caustics; Child; Child, Preschool; Citrates; Citric Acid; Copper Sulfate; Detergents; Drug Combinations; Electric Power Supplies; Endoscopy; Esophageal Stenosis; Esophagus; Household Products; Humans; Mice; Radiography; Sodium Bicarbonate; Sodium Hypochlorite; Steroids

Adenocarcinoma of the esophagus is found almost exclusively at the level of the cardia. It is exceptional to find it in the middle part of the esophagus in the absence of involvement of the cardia. In the long term, caustic burns of the esophagus may favour malignant degeneration. The latter is always squamous cell carcinoma. In our patient, a 28 year old man, a cylindrical carcinoma of the thoracic esophagus was detected four years after the ingestion of concentrated sodium hypochlorite. The caustic burn followed by carcinoma were of special significance in this case owing to the development of an adenocarcinoma.

Topics: Adult; Burns, Chemical; Carcinoma, Adenoid Cystic; Caustics; Esophageal Neoplasms; Esophagus; Humans; Male; Precancerous Conditions; Sodium Hypochlorite

Topics: Animals; Burns, Chemical; Cornea; Corneal Injuries; Debridement; Eye Burns; Rabbits; Sodium Hypochlorite; Time Factors

Topics: Burns, Chemical; Cantharidin; Caustics; Chromates; Corrosion; Cresols; Environmental Exposure; Humans; Hydrochloric Acid; Mustard Compounds; Nitrates; Oxidation-Reduction; Phenols; Potassium Permanganate; Sodium Hypochlorite; Sulfuric Acids

Topics: Alkalosis; Bicarbonates; Burns, Chemical; Coma; Edema; Humans; Hyperglycemia; Hypernatremia; Infant; Insulin; Insulin Secretion; Male; Peritoneal Dialysis; Sodium; Sodium Hypochlorite; Water-Electrolyte Balance

Topics: Adult; Biopsy; Burns, Chemical; Child, Preschool; Esophageal Stenosis; Female; Humans; Intestinal Mucosa; Radiography; Sodium Hypochlorite

Topics: Animals; Burns, Chemical; Caustics; Dogs; Esophagus; Sodium Hypochlorite

Topics: Acetates; Acids; Adolescent; Adult; Alkalies; Ammonia; Anti-Bacterial Agents; Burns, Chemical; Carbonates; Child; Child, Preschool; Esophagoscopy; Esophagus; Female; Humans; Hydrochloric Acid; Infant; Iodine; Lactates; Male; Nitrates; Phenols; Prednisolone; Silicon Dioxide; Silver Nitrate; Sodium Hydroxide; Sodium Hypochlorite; Sulfates; Sulfuric Acids

Topics: Adult; Burns, Chemical; Child, Preschool; Eye Burns; Female; Humans; Male; Sodium Hypochlorite

Topics: Burns; Burns, Chemical; Caustics; Child; Eating; Esophageal Stenosis; Esophagoscopy; Humans; Sodium Hypochlorite; Toxicology