Caustic effects of chemicals: risk factors for complications and mortality in acute poisoning

The aim of the study was to investigate the incidence of respiratory and gastrointestinal complications in relation to the type of caustic substance and to identify the risk factors for mortality in patients with acute caustic ingestion. We retrospectively reviewed all caustic substance exposures reported to the National Toxicological Information Centre in Slovakia during the 18-year period (1998-2015). Only patients who underwent an endoscopic evaluation within 24 h with positive findings were included in the study (n = 271). The median age was 37 years (1-87). Accidental exposures prevailed over suicidal intent (202/64). The median length of hospital stay was 6 days (1-45). Acid ingestion was associated with increased risk of respiratory (OR 6.5, p < 0.001) as well as gastrointestinal complications (OR 4.8, p < 0.001). The overall mortality was 8.2%. Twenty six of the patients died after ingestion of strong acids (n = 22), paraquat (n = 3), and glyphosate (n = 1). Grade IIIb of caustic injury (OR = 28.2, p < 0.001), ingestion of hydrochloric acid (OR = 7.3, p = 0.003), and suicidal intent (OR = 11.7, p < 0.001) were independent risk factors for fatal outcome after caustic ingestions. Mortality risk was significantly increased in patients C55 years (OR = 4.5, p < 0.001). The results of current analysis of the caustic exposures in Slovakia indicate that ingestion of strong acid, particularly hydrochloric acid, suicidal intent, grade IIIb of caustic injury, and age over 55 years are the most important risk factors for fatal outcome as well as predictors for systemic complications.