Tunisian Journal of Emergency Medicine

Severe Upper Airway Obstruction And Mediastinitis After Accidental Quaternary Ammonium Ingestion : Highlighting The Role Of Early Parenteral Nutrition

Authors

  • Marwen Boughriba

    Faculté De Médecine De Sfax

  • Achraf Khemakhem

  • Hejer Aloulou

  • Marwa Ben Abdallah

  • Mariam Mallek

  • Rim Karray

  • Olfa Chakroun

  • Noureddine Rekik

DOI:
https://doi.org/10.66759/d2r7ks52
Keywords:
Caustic ingestion, Mediastinitis, Poisoning, Quaternary ammonium, Nutrition
Abstract
Background : Quaternary ammonium compounds (QACs) are widely used disinfectants and surfactants. Poisining following ingestion is rare but may threaten both airway and upper gastrointestinal integrity. Case presentation : A 21‑year‑old woman with no prior medical history presented after accidental ingestion of a QAC‑based disinfectant at work, with vomiting, hematemesis, hypersalivation, and progressive respiratory distress. Examination showed extensive oral mucosal necrosis and impending laryngeal edema requiring early intubation. Laboratory tests revealed leucocytosis, lymphopenia, hypocalcemia, prolonged prothrombin time, and elevated creatine kinase. Contrast‑enhanced Computed Tomography (CT) demonstrated grade IIa esophagitis, mediastinitis, and gastritis with mild peritoneal effusion but no perforation. Treatment included proton pump inhibitors, corticosteroids, broad‑spectrum antibiotics, and a total parenteral nutrition protocol ensuring nutritional intake during gastrointestinal rest. Laparoscopic exploration confirmed inflammatory peritoneal effusion without gastric perforation, and recovery was favorable. Conclusion : Accidental QAC ingestion may mimic classical caustic injury while presenting with mediastinitis and peritoneal effusion without perforation, requiring early multidisciplinary care and optimized nutritional support.
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Published
30-09-2026
Issue
Vol. 4 No. 3 (2026): TJEM 2026: Vol.4 Issue 3
Section
Case Reports
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How to Cite

Severe Upper Airway Obstruction And Mediastinitis After Accidental Quaternary Ammonium Ingestion : Highlighting The Role Of Early Parenteral Nutrition. (2026). Tunisian Journal of Emergency Medicine, 4(3). https://doi.org/10.66759/d2r7ks52

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