Alkalinity of non-industrial cleaning products and the likelihood of producing significant esophageal burns

Howell, John M.

doi:10.1016/0735-6757(91)90114-y

Cited by 5 publications

(3 citation statements)

References 10 publications

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“…Solutions of 5-10% of ammonium chloride have not been demonstrated to cause ocular irritation upon contact [10]. Fatal ingestions due to 0.2% concentration may have pHs high enough to significantly increase the risk of serious esophageal burns, although other factors also contribute to risk of esophageal damage [11]. Fatalities from ingestions of aqueous solutions of benzalkonium chloride have rarely been reported and usually involve products of greater than 10% concentration [12].…”

Section: Discussionmentioning

confidence: 99%

A complicated hospitalization following dilute ammonium chloride ingestion

et al. 2009

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Introduction: Unintentional ingestions of dilute (<7.5%) cleaning solutions containing ammonium chloride typically do not cause serious harm. We present a case of an intentional ingestion of a dilute ammonium chloride solution resulting in significant morbidity.Case Report: A 60-year-old woman with bipolar disorder presented one hour after an intentional ingestion of approximately 15 fluid ounces (500 mL) of an algae and odor humidifier treatment containing a total of 2.25% ethyl ammonium chloride. Initial complaints included nausea with a single episode of nonbilious, nonbloody emesis, mild shortness of breath, and chest and epigastric pain. Physical exam was remarkable for bilateral wheezing and epigastric tenderness. An emergent endoscopy demonstrated a Grade 2b caustic injury in the esophagus and a Grade 3b injury in the stomach. Due to persistent cough, copious oral secretions, and worsening hoarseness, the patient was intubated and admitted to the ICU. Her course was complicated by mild hypotension, nonanion gap metabolic acidosis, and oliguria treated successfully with intravenous (IV) fluids. She also developed bilateral pneumonias later in the hospital course. Bedside bronchoscopy showed laryngeal edema and mucosal injury to the segmental level. The patient underwent tracheostomy on hospital day 6. An upper GI swallow study revealed poor esophageal motility in the mid-to lower third of the esophagus. The patient gradually tolerated oral fluids and on hospital day 20 had her tracheostomy tube removed. The patient was subsequently transferred to the psychiatric ward on hospital day 22.Conclusion: Intentional ingestions of dilute ammonium chloride solutions can cause serious injury to the gastrointestinal tract and pulmonary systems, which can result in a complicated and prolonged hospitalization.

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Section: Discussionmentioning

confidence: 99%

A complicated hospitalization following dilute ammonium chloride ingestion

et al. 2009

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“…The house cleaning solution which is made of aqueous ammonia, also known as ammonia water or aqua ammonia, is composed of ammonium hydroxide and belongs to the category of strong alkalis (pH = 12); cleaning solutions are generally diluted to a concentration < 7.5% [ 7 , 8 ]. Several cases of corrosive substance ingestion have been published over the last decade, but there are few data concerning the description of aqueous ammonia solution induced injuries [ 9 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Submucosal hematoma: a new distinctive sign during emergency upper digestive endoscopy for ammonia ingestion

Gelu-Siméon

Chuong²,

Saliba

et al. 2018

BMC Gastroenterol

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BackgroundSubmucosal hematoma has never been associated with caustic injuries. Long-term follow-up of patients who ingested ammonia is not well known and ammonia ingestion is rare.MethodsIn a Single-center observational study, prospective data were collected from 2009 to 2013, in patients over the age of 14 years old referred for ammonia ingestion. The emergency and follow-up endoscopic data and the outcome were reported.ResultsAmmonia ingestion occurred in 43 patients. Submucosal hematoma of the gastric wall was a distinctive endoscopic sign observed in 15 (34.8%) cases. Oropharyngeal lesions were present in 30 (69.8%) patients, which was associated with ingestion with suicidal intent in 18 cases. Mild and severe endoscopic lesions (grade IIB to IIIB) were found in 16 (37.2%) cases with 10 (23.3%) cases presenting submucosal hematoma at initial endoscopy. A complete spontaneous gastric healing was frequently observed in 36 (83.7%) cases. In 11 cases with submucosal hematoma, a favourable outcome was observed with a medical treatment, however 6 of these patients had severe endoscopic lesions initially.ConclusionsSubmucosal hematoma of the gastric wall is an endoscopic sign occurring frequently in ammonia ingestion. Submucosal hematoma should be distinguished from necrosis in order to avoid false misclassification in favour of more severe lesions, which would lead to an abusive surgery.Electronic supplementary materialThe online version of this article (10.1186/s12876-018-0809-8) contains supplementary material, which is available to authorized users.

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“…Although the pathology of acute lye injury to the esophagus is well recognized, producing rapid and extensive liquefaction necrosis that is both timeand concentration-dependent [5,6], little information is available about the critical concentration for its effect or about the early sequence of changes that lye produces in esophageal epithelial structure and function. Indeed, reports in the literature vary considerably with respect to the strength and quantity of lye required to injure the esophagus [7,8]. For this reason, we sought to model lye ingestion in humans in vitro by luminally exposing the rabbit esophageal epithelium to lye while mounted in Ussing chambers.…”

Section: Introductionmentioning

confidence: 99%

Critical pH Level of Lye (NaOH) for Esophageal Injury

Atuğ

Dobrucalı

Orlando³

2009

Dig Dis Sci

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Lye (NaOH) injury to the esophageal epithelium is both pH- and time-dependent, but requires a minimum pH of 11.5. At pHs >or=11.5, lye produces liquefaction necrosis, an injury that involves both cellular and junctional barriers, and which markedly increases epithelial permeability to ions and uncharged molecules. Based on these results, non-industrial cleaning products in the home are likely to be safer if they have a concentration of lye below pH 11.5.

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Alkalinity of non-industrial cleaning products and the likelihood of producing significant esophageal burns

Cited by 5 publications

References 10 publications

A complicated hospitalization following dilute ammonium chloride ingestion

A complicated hospitalization following dilute ammonium chloride ingestion

Submucosal hematoma: a new distinctive sign during emergency upper digestive endoscopy for ammonia ingestion

Critical pH Level of Lye (NaOH) for Esophageal Injury

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