Citation

Aggarwal A, Bansal A, Dixit A, Sharma V. J. Postgrad. Med. 2013; 59(2): 152-153.

Affiliation

Department of Medicine, University College of Medical Sciences (University of Delhi) and Guru Teg Bahadur Hospital, Delhi, India.

Copyright

(Copyright © 2013, Medknow Publications)

DOI

10.4103/0022-3859.113837

PMID

23793321

Abstract

Sulfuric acid is a commonly used chemical in households for cleansing toilet bowl. It acts as a corrosive agent and results in local irritation and mucosal injury and, therefore, causes esophageal and gastric injury. Sulfuric acid at 8-10% concentration is used as a toilet bowl cleaner and is a common accidental poison in India. It can cause injury of variable severity to the esophageal and gastric mucosa. This may manifest endoscopically as mucosal edema, erythema, ulcerations, necrosis, bleeding, and even perforation. The site and severity of injury depends on a number of factors including dosage of the agent, its concentration, nature (acidic or alkaline) of corrosive, and whether the patient was empty stomach. Delayed complications include stricture formation resulting in dysphagia or gastric outlet obstruction. Most patients report mild to severe oropharyngeal, esophageal, and gastrointestinal damage. Heavy ingestion of concentrated (52-100%) sulfuric acid can also lead to hypotension, metabolic acidosis, and disseminated intravascular coagulation. In such patients, death can occur from cardiovascular collapse or shock secondary to chemical peritonitis due to gastrointestinal tract perforation.

This, to the best of our knowledge, is the first report of cardiac manifestations following corrosive ingestion. Such changes can occur if corrosive ingestion leads to hypotension resulting in cardiac necrosis and then causing elevation of myocardial enzymes and ECG changes. However, our patient did not have any episode of hypotension. We believe that the trans-mural spread of inflammation across the esophageal wall into the mediastinum and then injuring the myo-pericardium might have been responsible for these manifestations.

A 15-year-old boy presented with a history of accidental ingestion of about 50 ml of toilet cleaner (diluted 8% sulfuric acid) around 8 h back. Immediately after ingestion, he developed a sensation of local irritation and burning sensation in his oral cavity. There were no respiratory complaints or hemodynamic instability.... His ECG changes persisted for more than a week, but cardiac enzymes returned to normal levels on 7 th day with troponin at 0.08 ng/mL (<0.1 ng/mL) and CK-MB at 12 U/L. His echocardiograms done on 7 th and 12 th day after presentation were absolutely normal.

Language: en