Nutritional therapy in the treatment of acute corrosive intoxication in adults

Introduction: Acute intoxications with corrosive substances can cause severe chemical injuries of the upper gastrointestinal tract, most often located in the mouth, pharynx, esophagus, stomach and duodenum. If a patient survives the acute phase of intoxication, regenerative response may result in esophageal and/or gastric stenosis, and increased risk of esophageal and gastric cancer. Such intoxication may be fatal due to perforation or tracheal necrosis. Enteral nutrition is a nutritional method when nutritional substances are administered through specially designed tubing placed through the nose or percutaneously, directly into the GIT. Aim: The aim of this study is to describe the methods of artificial nutrition in patients with acute corrosive intoxications and the importance of nutritional support in the treatment of these intoxications. Discussion: Nutrition in the treatment of acute corrosive intoxications is one of the most important therapeutic processes that largely contribute to faster recovery of the post-corrosive injuries of upper GIT, stabilization of biologic, immunologic and metabolic parameters, and reduction of length of stay in hospital Aim of the treatment of acute corrosive intoxications is to prevent perforation and progressive fibrosis, and esophageal and gastric stenosis. There are different and often conflicting positions, on the conservative treatment of acute corrosive intoxications in adults. Such treatment mainly consists of anti-secretory treatment, antibiotics and intensive hyper-alimentation, aiming to prevent late post-corrosive intoxications. Conclusion: It is considered that nutritional support plays a major role in maintenance of metabolic processes and prevention of severe metabolic complications that could additionally aggravate the condition and impair the treatment. Key words: corrosive poisonings, deglutition, deglutition disorders, nutritional therapy, enteral nutrition, parenteral nutritio

Nutritional therapy in the treatment of acute corrosive intoxication in adults

Introduction: Acute intoxications with corrosive substances can cause severe chemical injuries of the upper gastrointestinal tract, most often located in the mouth, pharynx, esophagus, stomach and duodenum. If a patient survives the acute phase of intoxication, regenerative response may result in esophageal and/or gastric stenosis, and increased risk of esophageal and gastric cancer. Such intoxication may be fatal due to perforation or tracheal necrosis. Enteral nutrition is a nutritional method when nutritional substances are administered through specially designed tubing placed through the nose or percutaneously, directly into the GIT. Aim: The aim of this study is to describe the methods of artificial nutrition in patients with acute corrosive intoxications and the importance of nutritional support in the treatment of these intoxications. Discussion: Nutrition in the treatment of acute corrosive intoxications is one of the most important therapeutic processes that largely contribute to faster recovery of the post-corrosive injuries of upper GIT, stabilization of biologic, immunologic and metabolic parameters, and reduction of length of stay in hospital Aim of the treatment of acute corrosive intoxications is to prevent perforation and progressive fibrosis, and esophageal and gastric stenosis. There are different and often conflicting positions, on the conservative treatment of acute corrosive intoxications in adults. Such treatment mainly consists of anti-secretory treatment, antibiotics and intensive hyper-alimentation, aiming to prevent late post-corrosive intoxications. Conclusion: It is considered that nutritional support plays a major role in maintenance of metabolic processes and prevention of severe metabolic complications that could additionally aggravate the condition and impair the treatment

The role of hemodialysis in treatment of acute acetic acid poisonings

The aim of this study is to show the importance of hemodialysis as an active method in treatment of acute acetic acid poisonings. Its main role is to support the renal function during the state of the intoxication when patients develop acute renal failure. We analyzed data from a 10-year period, a total of 71 patients who ingested acetic acid, either intentionally or accidentally. Patients with a need of hemodialysis (HD) treatment underwent 3- to 4-hour HD sessions every day or every second day, according to clinical assessment, as needed, until recovery of kidney function. In the period between 2006 and 2015 at the university clinic for toxicology and urgent internal medicine, we hospitalized 6,106 patients with different kinds of intoxication, of which 1.162% ingested concentrated acetic acid; 47 patients were female and 24 were male. The minimal age of patients was 18 and the maximal 74 years. A total of 28 (39.43%) of the patients developed acute renal failure and in 10 patients (14.08%) we used hemodialysis as a part of the treatment. The maximum number of performed sessions in one patient was five and the minimal number of performed sessions in one patents was only one session. The use of heparin led to fatal bleeding in 4 patients. The mortality rate was 7% and most of the cases resulted in fatalities during the first 96 hours after ingestion. Acetic acid poisonings are one of the most dangerous intoxications seen in clinical toxicology. The use of hemodialysis in some of the patients who develop acute renal failure can be of great importance and it should be put into official treatment protocols due to its great number of advantages in renal function support

Post-corrosive complications in different age intervals

Background: Acute corrosive poisonings occur due to the ingestion of acids,bases, salts from heavy metals, iodine tincture and many other chemicals, which are usually used as antiseptic cleaning solutions. Objective: The aim of the study is to demonstrate the influence of patients’age on the outcome of an acute corrosive poisoning. Design: Retrospective study which analyzed clinical records from the period 2007-2011. Patients: Retrospective material was analyzed from 415 patients, with ages between 14 and 90 years, who were admitted and treated at the University Clinic of Toxicology, Skopje, Republic of Macedonia. Interventions: Urgent upper endoscopy (esophagogastroduodenoscopy) in the first 12-24 hours for evaluation of the post-corrosive injuries in the upper gastrointestinal tract. Results: The research findings include 415 patients with corrosive poisonings, of which 295 (71.08%) were females and 120 (28.92%) were males. Also, 388 (93.49%) of the patients abused the corrosive substance with suicidal intentions, while 27 (6.50%) used it accidentally. Conclusions: The prevalence of poisonings with corrosive chemicals among the general population is at a rise, especially in countries that are less developed and where the health standards haven’t evolved as much as in developed and rich world countries. Easy access to corrosive chemicals in everyday life has brought upon the rise in the percentage of post-corrosive complications. Our study has demonstrated that the age of patients with acute corrosive poisonings has a statistically significant influence on the outcome of such poisonings. Key words: corrosive poisonings, esophagogastroduodenoscopy, gastrointestinal trac

Severe mushroom poisoning in one Macedonian family

Collecting and consuming wild mushrooms is a historical tradition in many European countries, including The Republic of Macedonia. This activity is predominantly performed in the period between June and October, when the weather is warm and humidity in the air and soil is at higher levels. The Amanita genus consists of 500 different species of mushrooms; among these, Amanita phaloides, Amanita virosa and Amanita verna are most commonly found in oak forests in our country. These species are highly poisonous and because they can be similar to some edible mushrooms, they have often been misidentified. Their consumption causes severe intoxication