Sir.—The article by Bergeson et al, which appeared in the January issue of the Journal (129:49, 1975), was a fine discussion of the stated problem. The management of their first case was, however, suboptimal in my opinion. This 20-month-old boy ingested lighter fluid. He choked, coughed, vomited after ingestion, and was seen in the emergency room that night. He was sent home after a normal chest roentgenogram had been obtained. He was seen in the outpatient clinic the next day with fever, "harsh breath sounds," and "right middle lobe and left lower lobe infiltrates." At this point he should have been admitted to the hospital. Instead, he was given ampicillin sodium and sent home.
The authors themselves point out that "pleural effusion, pneumothorax, pneumomediastinum, subcutaneous emphysema, and pneumopericardium have been encountered as complications of hydrocarbon ingestion" (p 51). Others have reported serious cardiac complications following hydrocarbon ingestion.1 Most