What is a corrosive substance?
Corrosive; means having chemical or physical, corrosive and destructive effects. Cleaning products, watch batteries, drain openers, paint removers, washing powders, salt spirits, pickles, sink cleaners, hair bleaches are examples of corrosive substances.
During adolescence, children drink large amounts of corrosive substances, mostly for the purpose of suicide. However, young children almost always ingest corrosive substances accidentally and in small quantities. The amount of substance consumed is usually small, as young children taste these substances curiously and stop when they realize that they do not taste good and are burning.
We see that the cases of corrosive substances in Turkey generally increase during the holiday cleaning periods. Colorful detergent bottles and buckets filled with foam are very attractive to children.
The first symptoms in children who drink corrosive substances are as follows;
There may be no symptoms at first after ingesting the corrosive substance. Or, damage may occur around the mouth, lips, inside the mouth, larynx and pharynx, esophagus (oesophagus), and stomach. The child may not be able to swallow his saliva. In addition to drooling from the mouth, dysphagia, pain in the chest, abdominal pain, stridor, gasping/groaning breathing may occur.
Corrosive substances damage to tissues:
Bleach and other kitchen detergents cause relatively superficial burns and do not cause permanent damage, while cleaning materials containing strong alkali such as lime remover or strong acid such as degreaser do not completely dissolve in the esophagus. They can cause layer and all-around burns. Severe burns can cause perforation of the esophagus or stomach, mediastinitis and eventually death. The damage is proportional to the concentration of the corrosive substance and the contact time with the mucosa.
Even if everything seems normal after drinking the corrosive substance, even if the child can swallow his saliva and there is no burn wound in his mouth, if there is a history of drinking this substance, it is considered as having a burn in the esophagus until proven otherwise.
The healing process of damaged tissues is as follows;
The mucosa is renewed within three weeks after burning, the burn becomes epithelialized. However, there is no regeneration of burned muscle tissue; The burned muscle tissue is replaced by fibroblasts and collagen tissue, and the wound gradually shrinks. Within months, this tissue gradually hardens and creates a narrowing.
If your child drinks a corrosive substance, the child should never be vomited. The patient is not allowed to drink water or milk, yoghurt, etc. The stomach is not washed by inserting a hose through the mouth or nose. The general condition of the child who drinks corrosive substances in the health institution; respiration and circulation are evaluated. If there is respiratory distress, a chest X-ray is taken. In the first 48 hours, each patient is considered to have a burn in the esophagus until esophagoscopy/endoscopy is performed to determine whether there is a burn in the esophagus. If the burn is not observed, no further examination or treatment is required and the patient is discharged. In some centers, instead of performing esophagoscopy under general anesthesia, every patient is treated and followed up as if they had a burn. In addition, considering that severe lesions rarely develop in patients who drink bleach, esophagoscopy may not be necessary in all cases.
Oral feeding of each patient who ingests corrosive substances is interrupted (minimum first 24 hours).
The patient is hospitalized, intravenous access is established and fed with serum.
Intravenous steroids can be given to limit scar development.
Intravenous antibiotics can be given to prevent difficulty in swallowing and lung infection due to aspiration.
Since motility will be affected, antacid medication can be given intravenously to reduce acid reflux.
After the child with severe burns starts feeding, a protein-based liquid diet is given.
A contrast-enhanced esophagus-stomach-duodenum radiograph is taken when the third week is completed in the child who develops swallowing difficulty.
If stenosis is detected in the film, periodic dilatation (expansion) operations are started.
If these are not successful, the narrowed esophagus piece can be removed and a new tube can be made here from the stomach or intestines.
However, the concept of “the best esophagus is the patient’s own esophagus” should not be forgotten. The only thing to do to avoid the need for all these attempts is not to keep such items, which attract the attention of children with their colors and smells, in places where children can reach them.
