Epidemiology of severe poisonings caused by ingestion of caustic substances.

Acute poisoning with corrosive substances can cause severe chemical injuries of the upper part of the gastrointestinal tract. They are most frequently localized in the oesophagus and stomach. If the patient survives the acute phase of poisoning, the regenerative response can result in oesophageal and/or gastric stenosis and a higher risk of oesophageal and stomach cancer. Seven-years clinical material was evaluated for this study (2000-2006) with a total number of 517 patients, hospitalized and treated at the Urgent Internal Medicine and Toxicology Clinic, University Clinical Centre, Skopje, Republic of Macedonia. The evaluation of the caustic poisonings was followed on the basis of anamnesis and hetero-anamnesis, physical examination of the patient, and status of the local changes to the oral mucosae, tongue, palate, and pharynx. The patients were assessed by the following techniques of visualization: urgent oesophagoduodenoscopy in the first 24 hours after the ingestion, control oesophagoduodenoscopy (15 and 25 days after ingestion), X-ray of oesophagus, gaster and duodenum with gastrograph (25-30 days after the ingestion), as well as a routine laboratory examination (blood count, urea, creatinine, enzyme, protein and lipid status, serum transferin, etc), following also the actual body mass index (BMI). The presented results show that the dominating patients were female [n = 368 patients (71.79 %), p < 0.001] and Christian by religion [n = 263 (50.87 %), p > 0.05], with the majority having had secondary education [n = 322 (62.28 %), p = 0.001]. The most frequently misused substance was chlorine hydrogen acid [n = 245 patients (47.38%)]., At the first urgent oesophagoduodenoscopy examination the majority of patients had II A (n = 190) and II B (n = 136) grade damage (x(2) = 44.0; p < 0.05). One hundred patients, or 19.34 %, were dismissed from the hospital with stenosis of the oesophagus and stomach. The high percentage of stenosis was the major factor in the invalidity of these patients. A high mortality of 8.69 % (p > 0.05) was also stated. Of 517 patients, 62 (11.99 %) were poisoned with concentrated acetic acid. In 37 patients (59.67 %) acute renal failure developed as an acute complication and four patients (6.5 %) died as a consequence of the disordered renal function and the need for active dialysis treatment. Recovery of the renal function was established in 93.5 % of the patients. A total number of 138 haemodialyses (3.7/patients) were performed. Acute corrosive poisonings represent a serious socio-economic problem, as well as a diagnostic and therapeutic problem. They appear most frequently in a population that is in a period of life when the person is most creative and efficient in terms of working capacity. The treatment is expensive and is an economic burden on the social community. Despite all the current therapeutic treatments and efforts made to decrease the mortality and late morbidity, intoxication with corrosive substances remains a difficult medical problem.