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Full Version: Intentional alkali ingestion in a 65-year-old female
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Intentional alkali ingestion in a 65-year-old female


A65-year-old female with a history of mental illness presented to the ED after consuming two glasses of liquid DranoTM approximately three hours prior to presentation in a suicide attempt. Fifteen minutes after consuming the drain cleaner, the patient developed epigastric pain and difficulty swallowing and called emergency services. On presentation, she complained of sharp epigastric pain rated at a level of 8 (on a scale of 0 to 10), nausea and difficulty swallowing. She denied shortness of breath or throat tightness, or any other coingestions.


GENERAL APPEARANCE: The patient was awake and alert and appeared to be in no acute discomfort. She was speaking full sentences in a normal voice, tolerating her secretions.
Temperature 98◦F (36.6◦C)
Pulse 80 beats/minute
Blood pressure 145/90 mmHg
Respirations 22 breaths/minute
Oxygen saturation 99% on room air
HEENT: PERRL, EOMI; posterior oropharynx erythema without swelling, exudates or ulcerations.
NECK: Supple, no anterior tenderness to palpation or crepitance.
CARDIOVASCULAR: Regular rate and rhythm without rubs, murmurs or gallops.
LUNGS: Clear to auscultation bilaterally.
ABDOMEN: Soft, nondistended, epigastric tenderness to palpation without rebound or guarding.
RECTAL: Brown stool, hemoccult negative.
EXTREMITIES: No clubbing, cyanosis or edema.
PSYCHIATRIC: Suicidal ideations; denied homicidal ideations, visual or auditory hallucinations.
A peripheral intravenous line was placed, and blood was drawn and sent for laboratory testing. The patient was not allowed to have anything by mouth, and a 1-liter normal saline IV bolus was administered. Laboratory tests revealed a leukocyte count of 19 K/μL (normal 3.5–12.5 K/μL); the remainder of her laboratory tests (including hematocrit, electrolytes, BUN, creatinine, glucose, anion gap, aspirin and acetaminophen levels) were within normal limits.

What is your diagnosis?

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infected erostions in pharynx and oesophagous
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