S4579 Survival After Ingestion of Sodium Metasilicate: A Case Report

Introduction: Sodium Metasilicate is a caustic, alkaline agent (pH 12.5), that can cause serious injury. It can cause skin, eye, and respiratory tract burns when swallowed, inhaled, or exposed to vapor. There are only 2 documented cases of exposure, both of which have caused death due to either respiratory or gastrointestinal compromise. Based on these reports and our patient, it appears that the severity of injury from ingestion is directly correlated with quantity consumed and even at small doses, consequences of ingestion can be severe. Case Description/Methods: Patient is an 18-year-old man with a past medical history of major depressive disorder and SI. Patient initially presented to the emergency department (ED) with complaints of sore throat, abdominal pain, and chest tightening. Patient was vomiting upon arrival to the ED. En route, the patient reported ingesting 1 mL of sodium metasilicate prior to the start of his symptoms. Initial imaging with abdominal x-ray and computed tomography of the chest, abdomen, and pelvis were remarkable for stage 2 esophageal wall edema and no other acute process. Emergent esophagogastroduodenoscopy was performed and showed ulceration, erythema, and congestion throughout the wall of the esophagus and stomach compatible with caustic injury, classified as Zagar Grade 2B. Patient was kept nil per os for at least 48 hours to allow for bowel rest/healing and started on 40 mg proton pump inhibitor (PPI) which would be continued until reevaluated endoscopically 2 months later. After 48 hours of improving symptoms, he was switched to clear liquid diet. His diet was then advanced as tolerated and was later discharged to inpatient psychiatric facilities. Discussion: Sodium metasilicate ingestion and poisoning is rare and the effects of its ingestion can be devastating. The 2 prior reported cases resulted in death. Both of which, involved ingestion of approximately 150 mL of sodium metasilicate, a significant increase when compared to our case, with just 1 mL ingested. The first reported case reported a very quick time of death, being about 1-1.5 hours after ingestion and aspiration. The second case led to death 3 months later from malnutrition due to complications with his enteral feeding device secondary to pyloric stenosis. This suggests that outcomes from sodium metasilicate poisoning are directly correlated to amount consumed. This case also shows that a small amount of sodium metasilicate, 1 mL in this case, can cause a great deal of harm, indicating that its ingestion should be taken seriously and be treated emergently.