Alkaline and Acidic Caustic Ingestions #Alkaline #Acidic #Caustic #Ingestions #diagnosis #toxicology

Caustic Injury to the Esophagus after Disinfectant Ingestion This is what the esophagus looks like when you ingest disinfectant Dr. Peter Masiakos @peter_masiakos #Esophagus #Caustic #Ingestion #Disinfectants #Clinical #Photo #Toxicology #Injury

Pediatric Button Battery Ingestion Most serious BB ingestions are not witnessed. Therefore, have a low threshold for considering BB ingestion in children with symptoms such as: Hematemesis, Airway obstruction, Drooling, Difficulty in breathing, Choking, Dysphagia, Refusal to eat Button batteries cause damage to tissues through: Discharge of an electrolytic current which hydrolyses tissue fluid and produces hydroxide which is a caustic (alkaline) Severity of tissue injury depends on: - Duration of mucosal contact - Location - Size of BB - Chemical composition of BB PeterboroughEM @PeterboroughEM #Button #Battery #Ingestion #toxicology #diagnosis #management #Pediatrics

Lip and Tongue Injuries Secondary to Toxic Ingestion (Disinfectant) Dr. Chethan Sathya, MD MSc @drchethansathya #Lip #Tongue #Ingestion #Disinfectants #Clinical #Photo #Toxicology #Caustic #Injury

Caustic Injury to the Esophagus after Disinfectant Ingestion Do NOT consume disinfectants in an attempt to kill COVID19. You do NOT want your oesophagous/larynx looking like this Caustic substances, such as bleach, can cause massive bleeding, perforations, extensive scarring leading to the inability to eat, inability to breathe due to swelling, higher risk of carcinoma, and obviously death. Dr Jasmina Kevric @DocJasmina #Esophagus #Caustic #Ingestion #Disinfectants #Clinical #Photo #Toxicology #Injury

Toxic Alcohol Ingestions Metabolic Acidosis - Osmolar Gap - Anion Gap - Ketones - Ca Oxalate Stones - Reduced Vision • Alcohol (Ethanol) • Methanol • Ethylene Glycol • Isopropyl Alcohol • Propylene Glycol - Dr. Kenar Jhaveri @kdjhaveri #Toxicology #Alcohol #Ingestions #comparison #table #osmolargap #diagnosis

Caustic Ingestion Extent Of injury by caustic agents determined by • Duration ot tissue contact • Ability of substance to penetrate tissues • Volume • pH • Concentration Clinical GI tract • Severe pain of lips, mouth, throat, chest, abdomen • Drooling, dysphagia, odynophagia • Vomiting, hematemesis Respiratory tract • Hoarseness, stridor • Epiglottitis, laryngeal edema and ulceration • pneumonitis, Impaired gas exchange Eyes • pain, tearing, irritation • Clouding of cornea, decreased vision Skin • Dribble marks on tie face, chest, and legs • First, second, or third degree burns #Caustic #Ingestion #Emergency #Diagnosis #Management

Caustic Esophageal Injuries Dr. Chandana Sri @santalum_aurum #Caustic #Esophageal #Injuries #esophagus #diagnosis #management #surgery #gastroenterology

Algorithm for evaluation of elevated serum alkaline phosphatase. #Algorithm #elevated #alkaline #phosphatase #AlkPhos #Elevation #Diagnosis #workup

Alkaline Phosphatase (ALP) Elevation - Differential Diagnosis Algorithm ALP: - Enzymes that catalyze hydrolysis of organic phosphate esters - Increased ALP from organs with disturbance (obstructed liver) or increased stimulation (placenta/Bone growth) Alkaline phosphatase sources: - Highest • Bone • Liver (80%) • Intestine - Other causes of elevation: • Intestine • Kidney • Placenta • Leukocytes • Malignancy Most common symptoms of Intrahepatic cholestasis: - Fatigue - Pruritis History and Physical examination: - Pruritis - Cholestasis - Drugs - Pregnancy - Renal disease - Bone symptoms - Pain -> RUQ -> US/Surgical consult ALP elevation DDX of Hepatic source: - Drugs - Primary biliary Cholangitis (PBC) - Other granulamatous disease - Infiltrative diseases - PSC - Other biliary diseases/Bile duct stricture/Stones #Alkaline #Phosphatase #ALP #Elevation #Differential #Diagnosis #Algorithm #hepatology

Fomepizole for Acetaminophen Toxicity • In cases where fomepizole and NAC were administered together, evidence has shown that the combination has contributed to a decrease in both hepatotoxicity and mortality. Most of the evidence has come from case reports and animal models • Currently, fomepizole is recommended for massive APAP ingestions (as in, ingestions over 500-600 mg/kg or in cases where 4-hour equivalent acetaminophen concentrations over 5000 umol/L). By Dr. Kathryn Watson @Kat_Watson #Fomepizole #Acetaminophen #Toxicology #pharmacology #management