Laundry detergent pod ingestion: Difference between revisions
 
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==Background==
==Background==
*Tide pods are laundry detergent pods that contain ethoxylated polymers, ethoxylated alcohols, surfactants, as well as other unknown proprietary ingredients. They are considered a caustic hydrocarbon injury, and contain significantly more concentrated detergent than standard liquid detergents.
[[File:Laundry detergent pods.jpg|thumb|Laundry detergent pods]]
[[File:Spring Meadow Tide pod.jpg|thumb|A "Spring Meadow" Tide Pod, a brand of detergent criticized for its candy-like appearance.]]
*Laundry detergent pods that contain more concentrated detergent than liquid detergents, and contain ethoxylated polymers, ethoxylated alcohols, surfactants, as well as other unknown proprietary ingredients
*Considered to cause caustic hydrocarbon injury
*Size and colorful packaging makes pods a risk for pediatric ingestion
*Size and colorful packaging makes pods a risk for pediatric ingestion


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In a review of 202 cases<ref>Beuhler MC, Gala PK, Wolfe HA, et al. Laundry detergent “pod” ingestions: a case series and discussion of recent literature. Pediatr Emerg Care. 2013; 29(6):743–747. </ref><ref>Valdez, A et al. Pediatric Exposure to Laundry Detergent Pods. Pediatrics. 2014.  http://media.kshb.com/pdf/Pediatric%20Exposure%20to%20Laundry%20Detergent%20Pods.pdf</ref>
In a review of 202 cases<ref>Beuhler MC, Gala PK, Wolfe HA, et al. Laundry detergent “pod” ingestions: a case series and discussion of recent literature. Pediatr Emerg Care. 2013; 29(6):743–747. </ref><ref>Valdez, A et al. Pediatric Exposure to Laundry Detergent Pods. Pediatrics. 2014.  http://media.kshb.com/pdf/Pediatric%20Exposure%20to%20Laundry%20Detergent%20Pods.pdf</ref>
*No effects - 24%
*No effects - 24%
*Vomiting - 66%
*[[Vomiting]] - 66%
*Respiratory complaints - 16%
*Respiratory complaints ([[cough]], [[stridor]], [[SOB]], [[pneumonitis]], [[respiratory failure|respiratory depression]]) - 16%
*altered mental status - 9%
*[[Altered mental status]] - 9%
**Can be profound
*Eye irritation - 8%
*Eye irritation - 8%
**Cause alkaline [[caustic eye exposure]], [[conjunctivitis]]
*Skin irritation - 0.5%
*Skin irritation - 0.5%
*Fever - 0.6%
**2nd/3rd degree [[chemical burns]] described<ref>Russell JL1, Wiles DA, Kenney B, Spiller HA. Significant chemical burns associated with dermal exposure to laundry pod detergent. J Med Toxicol. 2014 Sep;10(3):292-4</ref>
*[[Fever]] - 0.6%
 
*Red flag findings (indicate potential need for endoscopy, risk of perforation)-  stridor, excessive drooling, persistent vomiting


==Differential Diagnosis==
==Differential Diagnosis==
===Hyperthermia===
===[[Hyperthermia]]===
*Altered Metabolism
*Altered Metabolism
**[[Aspirin (Salicylate) Toxicity]]
**[[Aspirin (Salicylate) Toxicity]]
**Benzo or [[alcohol withdrawal]]
**[[Benzodiazepine withdrawal|Benzo]] or [[alcohol withdrawal]]
**[[Thyroid storm]]
**[[Thyroid storm]]
**dinitrophenols
**dinitrophenols
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**[[TCA toxicity]]
**[[TCA toxicity]]
*[[Malignant Hyperthermia]]
*[[Malignant Hyperthermia]]
**anesthestics
**anesthetics
*[[Neuroleptic Malignant Syndrome]]
*[[Neuroleptic Malignant Syndrome]]
**phenothiazines, [[Lithium]], LevoDopa
**[[Phenothiazines]], [[Lithium]], LevoDopa


===Hypothermia===
===[[Hypothermia]]===
*Exposure
*Exposure
**[[Ethanol Toxicity]]
**[[Ethanol Toxicity]]
**Sedative hypnotics
**[[Sedative/Hypnotics]]
**[[Opioids]]
**[[Opioids]]
**[[TCAs]]
**[[TCAs]]
**Phenothiazines
**[[Phenothiazines]]
**[[Insulin]] ([[Hypoglycemia]])
**[[Insulin]] ([[Hypoglycemia]])


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*Direct Stimulation
*Direct Stimulation
**[[Aspirin (Salicylate) Toxicity]]
**[[Aspirin (Salicylate) Toxicity]]
**[[Metabolic Acidosis]]
**[[Metabolic acidosis]]
**dintirophenol, pentachlorophenol
**dintirophenol, pentachlorophenol
**Hepatorenal failure
**[[Hepatorenal syndrome]]
**CNS stimulants (cocaine, amphet, theophylline)
**CNS stimulants (cocaine, amphet, theophylline)
*Tissue [[Hypoxia]]
*Tissue [[Hypoxia]]
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===Respiratory Depression===
===Respiratory Depression===
*Central Depression
*Central Depression
**antipsychotics
**[[Antipsychotics]]
**Chlorinated hydrocarbons
**Chlorinated hydrocarbons
**[[Sedative/Hypnotics]] ([[Ethanol Toxicity]], glycols)
**[[Sedative/Hypnotics]] ([[Ethanol Toxicity]], glycols)
**[[Tricyclic (TCA) Toxicity]]
**[[Tricyclic (TCA) Toxicity]]
**Lomitil
**[[Lomotil toxicity|Lomotil]]
*Muscle Failure
*Muscle Failure
**[[Organophosphates]]
**[[Organophosphates]]
**[[Marine Toxins]]
**[[Marine Toxins]]
**[[Nicotine Poisoning|Nicotine]]
**[[Nicotine Poisoning|Nicotine]]
**strychnine
**[[Strychnine]]
**botulism
**[[Botulism]]
**Mojave rattlesnake, Cobra
**Mojave [[rattlesnake]], cobra


==Evaluation==
==Evaluation==
*ABCs
*BMP
*Chem 7
*[[VBG]]/[[lactate]]
*Chest x-ray for respiratory complaints such as SOB/cough (there may be a delayed pneumonitis)
**[[Lactic acidosis]] reported<ref>Schneir AB, Rentmeester L, Clark RF, Cantrell FL. Toxicity following laundry detergent pod ingestion. Pediatric Emergency Care, 2013 Jun 1; 29(6): 741–2.</ref>
*Consider 6-hour observation period from time of ingestion, as some symptoms may be delayed  
*[[CXR]] if respiratory complaints  
**May be delayed [[pneumonitis]]
*Assess for co-ingestions if there is sufficient concern
*Assess for co-ingestions if there is sufficient concern
*Red Flag signs: stridor, excessive drooling, persistent vomiting--if 1 of 3 concerning symptoms are present, patient may need endoscopy within 12-24 hours (after 24 hours, greater risk of perforation). Consider toxicology consult.
 


==Management==
==Management==
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**Consider intubation for significant respiratory compromise
**Consider intubation for significant respiratory compromise
*Decontamination/eye irrigation if external exposure
*Decontamination/eye irrigation if external exposure
*[[Ondansetron]] for nausea
**Irrigate eye until pH neutralizes
*Correct electrolyte abnomralities if present
**Fluorescein exam for [[corneal abrasion|corneal defects]]
*[[Antiemetics]] for nausea
*Correct electrolyte abnormalities if present
*Contact Poison Control
*Contact Poison Control
*Red Flag signs: stridor, excessive drooling, persistent vomiting- may need endoscopy within 12-24 hours (after 24 hours, greater risk of perforation)


==Disposition==
==Disposition==
*Monitor in ED in conjunction with Poison Control recommendations
*Monitor in ED in conjunction with Poison Control recommendations
*Consider 6-hour observation period from time of ingestion, as some symptoms may be delayed
*Consider admission if respiratory compromise, altered mental status, or GI complaints resistant to symptomatic treatment
*Consider admission if respiratory compromise, altered mental status, or GI complaints resistant to symptomatic treatment


Latest revision as of 01:04, 6 September 2019

Background

Laundry detergent pods
A "Spring Meadow" Tide Pod, a brand of detergent criticized for its candy-like appearance.
  • Laundry detergent pods that contain more concentrated detergent than liquid detergents, and contain ethoxylated polymers, ethoxylated alcohols, surfactants, as well as other unknown proprietary ingredients
  • Considered to cause caustic hydrocarbon injury
  • Size and colorful packaging makes pods a risk for pediatric ingestion

Clinical Features

In a review of 202 cases[1][2]

  • Red flag findings (indicate potential need for endoscopy, risk of perforation)- stridor, excessive drooling, persistent vomiting

Differential Diagnosis

Hyperthermia

Hypothermia

Increased Respiratory Rate

Respiratory Depression

Evaluation


Management

  • ABCs
    • Consider intubation for significant respiratory compromise
  • Decontamination/eye irrigation if external exposure
  • Antiemetics for nausea
  • Correct electrolyte abnormalities if present
  • Contact Poison Control
  • Red Flag signs: stridor, excessive drooling, persistent vomiting- may need endoscopy within 12-24 hours (after 24 hours, greater risk of perforation)

Disposition

  • Monitor in ED in conjunction with Poison Control recommendations
  • Consider 6-hour observation period from time of ingestion, as some symptoms may be delayed
  • Consider admission if respiratory compromise, altered mental status, or GI complaints resistant to symptomatic treatment

See Also

External Links

References

  1. ↑ Beuhler MC, Gala PK, Wolfe HA, et al. Laundry detergent “pod” ingestions: a case series and discussion of recent literature. Pediatr Emerg Care. 2013; 29(6):743–747.
  2. ↑ Valdez, A et al. Pediatric Exposure to Laundry Detergent Pods. Pediatrics. 2014. http://media.kshb.com/pdf/Pediatric%20Exposure%20to%20Laundry%20Detergent%20Pods.pdf
  3. ↑ Russell JL1, Wiles DA, Kenney B, Spiller HA. Significant chemical burns associated with dermal exposure to laundry pod detergent. J Med Toxicol. 2014 Sep;10(3):292-4
  4. ↑ Schneir AB, Rentmeester L, Clark RF, Cantrell FL. Toxicity following laundry detergent pod ingestion. Pediatric Emergency Care, 2013 Jun 1; 29(6): 741–2.
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