Correspondence Acute corrosive poisonings - Frequent cause for fatal outcome To the editor: We are presenting you with a follow-up of our previously pub- lished study pertaining to acute corrosive intoxications, based on data collected over a ten-year period. Despite the efforts to decrease the incidence of acute corrosive intoxications through educational activities, media platforms and information brochures about the health risks from the ingestion and abuse of corrosive agents, these poisonings are still a serious medical and social issue with high mor- bidity and mortality rates. Our study showed that the occurrence of these poisonings was higher in populations of lower socioeconomic and health status, among which there were higher rates of suicide at- tempts, greater risk for long-term invalidity and even death. In most cases, the fatal outcome occurred during the first 96 h after the inges- tion and was caused by esophageal or gastric perforation, laryngeal edema, or corrosive agent aspiration with tracheal necrosis, septic shock and multisystem organ failure [1,2]. The data was based on clinical records obtained during a ten-year period, from 2006 to 2015, collected from the archives of the University Clinic for Toxicology in Skopje. For the requirements of this follow-up study we created a specialized protocol for the evaluation of patients whose life ended fatally. We registered individually the time and stage of death (whether it happened during the acute or chronic phase), which corrosive agent was ingested, the gender and age of patients, as well as the cause of death. We recorded results from the clinical files of 747 patients, who ingested corrosive chemicals, which was 11.47% from the total num- ber of registered poisonings during the ten year period (n = 6716, 2006–2015). The youngest patients' age registered was 14 years and the oldest was 90 years of age. The amount of ingested agent var- ied among the interval of 16.8 ± 8.6 ml (±95.000 CI: 14.9–18.7); the minimum amount ingested was 10 ml and the maximum was 50 ml. Corrosive agents were ingested for the purpose of a suicide attempt in 714 patients (95.85%), whereas 31 out of the 747 (4.14%) inges- tions were accidental. All patients were brought and hospitalized in the unit for intensive care during the first 24 h after ingestion. The overall mortality rate group was 5.48% from the total number of an- alyzed clinical files. Among the patients with IIB, III and IV grades of post-corrosive injuries, according to the Kikendals' classification, the mortality rate was 10.22%. All of the patients with fatal outcome had ingested the corrosive agent as a suicide attempt. Our results have shown that females had twice higher mortality rates than males; fatalities were more common among elderly patients (N60 years old) and death usually occurs during the acute phase. Autopsies of our patients revealed that most common findings were severe post-corrosive lesions along the entire upper gastrointestinal tract and appeared as deep and brown or black ulcers. In some of the specimens we were able to see the site of perforation. The most common cause of death was gastric perforation, complicated by an acute peritonitis, and also ma- jority of the fatalities occurred among the patients that ingested hy- drochloric acid. All of the results pertaining to the fatal outcomes were fully ob- served and statistically analyzed on a relevant number of patients, which is why we found them to be statistically significant and compara- ble to other available studies. A study by Behera et al. shows that fatal outcomes were usually recorded during the first 96 h after hospitalization, mainly due to the gastric or esophageal perforation, aspiration and tracheal necro- sis. They published that 53.85% of the patients died during the acute phase because of a sever sepsis [3]. An analogous study was con- ducted on a total number of 389 patients, which showed that cumu- lative survival rate in elderly patients were significantly lower than in younger ones. Patients aged about 65 years had a high mortality risk, mainly due to various co-morbidities such as hypertension, fre- quent usage of antibiotics and respiratory failure. The majorities of studies showed that the most abused corrosive chemicals were acids and bases, some of them regularly found in households as cleaning agents. A study on 271 patients showed that majority of fatal outcomes (N90%) happened after the ingestion of acids (hydro- chloric, sulfuric and nitric acid) [4-6]. Our study showed almost identical results with all previously men- tioned studies. The mortality rate was highest during the acute phase; fatal outcome usually happened after esophageal or gastric perforation, acute peritonitis, tracheal necrosis or perforation and multiple organ failure. Six patients died as a result of systemic complications and one of them died with a complicated pneumonia. One of the patients men- tioned died during a course of hemodialysis, in a clinical state of a severe hemodynamic shock. Declaration of interests All authors related to this manuscript do not have any financial or personal relationships that should be declared. Andon Chibishev University Clinic for Toxicology and Urgent Internal Medicine, Skopje, The Former Yugoslav Republic of Macedonia University “Goce Delchev”, Medical Faculty, Shtip, The Former Yugoslav Republic of Macedonia University “Ss. Cyril and Methodius”, Medical Faculty, Skopje, The Former Yugoslav Republic of Macedonia Corresponding author at: University Clinic for Toxicology and Urgent Internal Medicine, Boulevard “Vodnjanska 17”, Skopje, The Former Yugoslav Republic of Macedonia. E-mail address:acibisev@gmail.com (A. Chibishev). American Journal of Emergency Medicine xxx (2018) xxx–xxx YAJEM-57321; No of Pages 2 0735-6757/© 2018 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem Please cite this article as: Chibishev A, et al, , American Journal of Emergency Medicine (2018), https://doi.org/10.1016/j.ajem.2018.02.010