Laundry Detergent Pod Ingestions: Is There a Need for Endoscopy?

Introduction

Laundry detergent pod (LDP) exposures in children have resulted in several referrals to the emergency department. Signs and symptoms can include gastrointestinal symptoms (vomiting, drooling), neurological symptoms (depressed sensorium), or metabolic changes (lactic acidosis). There is limited literature on esophageal injury following LDP ingestions.

Case Series

We reviewed three cases of pediatric LDP ingestions that underwent an upper endoscopy in a tertiary care pediatric hospital. All of our patients were younger than 3 years old. The upper endoscopies revealed superficial esophageal erosions in two patients and erythema in the other. None of the patients had oral burns. Two of them developed swallowing dysfunction. Follow-up upper GI studies were normal.

Case Discussion

Our three patients ingested laundry detergent pods and all of them developed some degree of esophageal injury despite the absence of oral erythema, ulcers, or swelling. A review of literature suggests LDP exposures are more severe than non-pod detergents. Reasons as to why this may be remain unclear, although investigation into the ingredients and mode of delivery may help us to better understand. In a literature review, no esophageal strictures have been reported after LDP ingestion. We reviewed esophageal injury classification systems in an attempt to predict who may be at greatest risk for stricture based on initial findings.

Conclusion

Our case series demonstrates it is hard to predict esophageal injury based on signs and symptoms. Based on a literature review, long-term esophageal stricture is unlikely, but if gastrointestinal symptoms persist, it is reasonable to evaluate with an upper endoscopy. Larger studies are needed.     

Akt2, phosphatidylinositol 3-kinase, and PTEN are in lipid rafts of intestinal cells: role in absorption and differentiation

BACKGROUND AND AIMS: In intestinal Na absorptive cells, phosphatidylinositol 3-kinase (PI 3-K) is involved in rapid epidermal growth factor (EGF) stimulation of Na absorption by the brush border membrane (BBM) Na(+)/H(+) exchanger NHE3. However, how NHE3 is regulated by the PI 3-K pathway and the role of Akt2 are poorly defined. METHODS: The localization of Akt, PI 3-K, and NHE3 was determined by either immunocytochemistry and/or membrane fractionation using OptiPrep density gradient centrifugation. RESULTS: In ileum, active total Akt was present most in the villi and basal layer of the crypts, and Akt2 was mostly in villi. In villus cells, PI 3-K and Akt2 were mostly at the apical surface at which they were present partially in lipid rafts (LR). EGF increased PI 3-K and active Akt2 in ileal BBM at the same time that it increased PI 3-K-dependent trafficking of NHE3 to BBM and stimulation of Na absorption. However, Akt2 was only active in the detergent soluble (DS) pool and not LR of ileal BBM, which correlated with the presence of PTEN in LR. In Caco-2 cells, while EGF stimulated BB NHE3, Akt2 was active in both LR and DS pools. This correlated with the lack of PTEN in the LR of Caco-2 membranes. Akt2 also correlated with epithelial cell differentiation. Akt2 amount and activity were greater in differentiated than undifferentiated Caco-2 cells. CONCLUSIONS: These results suggest that LR may play an important role in determining the function of PI 3-K/Akt2 signaling, including stimulation of intestinal Na absorption. These results also suggest that LR-associated Akt2 may be involved in enterocyte differentiation.     

洁厕精致腐蚀性胃炎实验和治疗

目的 探讨酸性洗涤剂洁厕精对消化道黏膜的损害及治疗方法.方法 采用动物实验研究洁厕精对大白兔的急性毒性,对误服洁厕精患者观察其对消化道黏膜的亚急性和慢性毒性并探讨治疗方法.结果 经口腔灌注洁厕精15 ml,大白兔均于2 h内死于胃穿孔;患者误服洁厕精50 ml,经相关治疗7 d,胃镜检查提示腐蚀性胃体溃疡,治疗14 d,上消化道钡餐检查提示胃窦部缩窄炎症,治疗51 d,胃镜检查提示胃体胃窦溃疡疤痕形成.结论 酸性洗涤剂主要损害胃黏膜,急性期易致胃穿孔,亚急性期引起胃溃疡形成,慢性期引起瘢痕形成;治疗上,以口服纯牛奶、抑酸、止血为主;亚急性和瘢痕形成期均可以进行胃镜和上消化钡餐检查.     

Residual washing detergent in cotton clothes: a factor of winter deterioration of dry skin in atopic dermatitis

Although it is well known that the skin in patients with atopic dermatitis becomes drier in winter, the mechanisms of winter deterioration of dry skin are not fully understood. Our purpose was to determine whether residual washing detergent in cotton clothes plays a role in the winter deterioration of atopic dry skin. We studied 148 Japanese patients with atopic dermatitis who visited our dermatology clinic during winter months. They wore cotton underwear, which they had washed in cold tap water. We examined the distribution of dry skin on their trunks. We then asked them to stop washing their clothes with common anionic, additive-enriched detergents, and to use a nonionic, additive-reduced detergent for a period of two weeks. Photographs of 2 or 3 representative dry skin sites on the trunk were taken before and after the trial. By comparing the before-after trial photographs, the severity of dry skin at the end of the trial was assessed on a 5-point scale ranging from markedly improved to worsened. Of the 148 patients examined, 115 (78%) had widespread or localized dry skin on the trunk. The dryness of the skin was prominent around the shoulders. Of these 115 patients, 87 (76%) showed marked or moderate improvement of dry skin after the two-weeks of use of the nonionic, additive-reduced washing detergent. No patient showed worsening of the dry skin. These results suggest that residues of common washing detergents in cotton underclothes play an important role in the winter deterioration of dry skin in patients with atopic dermatitis who use cold tap water for washing their clothes.     

Simultaneous sodium lauryl sulphate testing improves the diagnostic validity of allergic patch tests. Results from a prospective multicentre study of the German Contact Dermatitis Research Group (Deutsche Kontaktallergie-Gruppe, DKG)

Background There is evidence that a higher skin susceptibility may induce nonspecific erythematous or weak positive reactions to contact allergens in patch testing. Objectives To evaluate whether simultaneous application of sodium lauryl sulphate (SLS) along with diagnostic patch tests with contact allergens can provide information regarding skin irritability which may help to discriminate allergic from nonspecific irritant reactions to contact allergens. Methods Between July 2001 and June 2003, this prospective study collected patch test data of 5971 patients from 19 centres in Germany and Austria in the Information Network of Departments of Dermatology (IVDK). In addition to contact allergens (standard series and eight known ‘problematic’ allergens with a low reaction index and a high positivity ratio: 1,3‐diphenylguanidine, amerchol L‐101, benzalkonium chloride, benzoyl peroxide, cocamidopropyl betaine, octyl gallate, phenyl mercuric acetate and propylene glycol), patches with SLS 0·5% and 0·25% aq. were applied. Reactions to the allergens and to SLS were analysed at the IVDK data centre. The association between an erythematous or positive reaction to a certain allergen and an irritant reaction to SLS was assessed with logistic regression analysis, at the same time controlling for the influence of age and sex. Results Of the 29 allergens of the standard series, 23 and 21 gave a higher percentage of nonspecific erythematous reactions in patients with an irritant reaction to 0·25% and 0·5% SLS, respectively, in comparison with SLS‐negative patients. All eight ‘problematic’ allergens gave an increased percentage of nonspecific erythematous reactions. Similarly, 22 and 21 allergens of the standard series gave a higher percentage of positive allergic reactions in patients with an irritant reaction to 0·25% and 0·5% SLS, respectively, and seven of the eight ‘problematic’ allergens gave a higher percentage of positive allergic rections (exception: octyl gallate). For most allergens, the markers of skin reaction (reaction index and positivity ratio) were worse in SLS‐positive patients. Differences were more pronounced when testing with SLS 0·25% than with SLS 0·5%. Conclusions Because there is a convincing association between skin irritability (evaluated by SLS test) and the degree of skin reaction to contact allergens, the SLS test may help in deciding whether a doubtful erythematous or weakly ‘positive’ skin reaction should be interpreted as allergic or irritant.     

Synergistic effect of detergents and aluminium phosphate on the humoral immune response to bacterial and viral membrane proteins

The influence of detergents on the immunogenic activity of the major outer membrane protein of Neisseria gonorrhoeae was investigated. Most detergents tested were found to enhance the immune response. This effect was synergistic with the adjuvant activity of AlPO₄. The combination of detergent and AlPO₄ showed a stronger adjuvant activity than Freund's complete adjuvant. The adjuvant effect was only observed with protein preparations with very low lipopolysaccharide content. The immunostimulating effect of detergents was also observed with meningococcal group C polysaccharide conjugated to a Haemophilus influenzae type b outer membrane protein and with the fusion protein of measles virus. The influence of some detergent parameters (critical micelle concentration, hydrophile-lipophile balance, charge) was investigated.