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Catastrophic Caustic Ingestion: A Case Report


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Fig. 1

EGD image of diffusely inflamed oesophageal mucosa
EGD image of diffusely inflamed oesophageal mucosa

Fig. 2

EGD image of inflamed oesophageal mucosa with diffuse ulceration and sloughing
EGD image of inflamed oesophageal mucosa with diffuse ulceration and sloughing

Fig. 3

Extensive burns and eschar to the patient's lower lip, chin, and left cheek
Extensive burns and eschar to the patient's lower lip, chin, and left cheek

Fig. 4

Bronchoscopy image of oedematous tissue of the epiglottis with diffuse tissue damage
Bronchoscopy image of oedematous tissue of the epiglottis with diffuse tissue damage

Fig. 5

Bronchoscopy image of oedematous vocal cords with diffuse tissue damage
Bronchoscopy image of oedematous vocal cords with diffuse tissue damage

Analgesic and sedative agents administered

DrugRouteDoseFrequencyHospital daysManufacturer
Fentanyl citrateIntravenous infusion100-300 milligrams/ hourContinuous infu- sion1-10Akorn, Inc., Lake Forest, Illinois, USA
propofolIntravenous infusion10 to 60 micrograms/ milligram/minuteContinuous infu- sion1-7, 10-15Pfizer, New York, New York, USA
lorazepamIntravenous injection1-6 milligramsEvery 4 hours as needed5-9Pfizer, New York, New York, USA
hydromorphoneIntravenous infusion4-15 milligrams/hourContinuous sion infu-8, 11-19Pfizer, New York, USA New York,
HydromorphoneIntravenous injection1-5 milligramsEvery 1 hour as needed7-19Pfizer, New York, New York, USA
Haloperidol dec- anoateIntravenous injection10 milligramsEvery 4 hours around the clock and as needed10-19Fresenius Kabi, Lake Zurich, Illinois, USA
Dexmedetomidine hydrochlorideIntravenous infusion0.4-1.5 micrograms per kilogram per hour (total 39 mcg)Continuous infu- sion9, 10Fresenius Kabi, Lake Zurich, Illinois, USA
Ketamine hydro- chlorideIntravenous infusion2 milligrams/kilogram/ hourContinuous infu- sion14-19Pfizer, New York, New York, USA

Endoscopic grading of caustic injuries (Zargar classification) [2,4,6]

GradeCharacteristics
0Normal mucosa
1Superficial oedema and erythema
2aFriability, haemorrhages, superficial ulcerations, exudates
3aGrade 2a plus deep and circumferential ulcerations
3bExtensive necrosis
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