Peculiarities of clinical and laboratory diagnostics and intensive therapy of acute poisoning by cauterizing substances in children

The relevance of the study problem is that among all chemical poisonings, the proportion of cauterizing substances is up to 20%, and fatal cases are about 3%. Diseases are characterized by severe medical, social and economic consequences.

Aim: Comparison of diagnostic indicators and the volume of intensive care in children with poisoning by cauterizing substances.

Materials and methods. A prospective cohort study was conducted in the ICU “Children’s City Clinical Hospital No. 1” in Novosibirsk in 2024. The study included 39 patients receiving intensive care for poisoning with cauterizing substances, codes according to ICD-10 — T54.2; T54.3; T57.2. The median age of the patients was 2 years (1; 2). All patients were admitted to the ICU within the first 2 hours after exposure to the etiological factor. Two groups were formed depending on the chemical structure of the cauterizing substance (group 1 included 17 children with acid poisoning; group 2 — 16 people with alkali poisoning). The study was conducted in 3 stages: days 1, 2, and 3 of stay in the ICU.

Results. A significant increase in inflammatory markers (leukocytes, C-reactive protein) was detected in group 1. Free hemoglobin in urine was not detected in any of the cases. Changes in esophagogastroduodenoscopy in the groups were comparable in terms of the frequency of diagnosis of erythema (p=0,532) and erosions (p=0,291), ulcers were diagnosed mainly with local acid exposure (p=0,043). The incidence of toxic nephritis in the two groups was 57 and 43% (p=0,537), and the incidence of confirmed pneumonitis was 75 and 25% (p=0,324). Forced diuresis was performed for all patients within 24 hours, the balance of infusion and diuresis was achieved by prescribing a loop diuretic in 30 patients. Indications for hemotransfusion are set for 2 children of the 1st group. Aspiration pneumonitis and local edematous syndrome were stopped by the appointment of systemic glucocorticosteroids in 100% of cases, antibacterial therapy in 88%, and inhalation therapy in 30% in equal proportions in groups. A higher, but not reaching the level of statistical significance, need for esophageal bougienage was determined for group 1 in 80% and for group 2 — 20% of cases (χ2=2,970, p=0,085).

Conclusion. Сhemical composition of cauterizing substances in mild and moderate poisonings had no significant effect on clinical and laboratory parameters. Acids in comparison with alkali, produced more severe changes in FGDS and higher frequency of somatic complications.