Laundry detergent pod ingestion: Difference between revisions
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==Background== | ==Background== | ||
* | [[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 | ||
==Clinical Features== | ==Clinical Features== | ||
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>: | 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% | ||
**Can be profound | |||
*Eye irritation - 8% | *Eye irritation - 8% | ||
**Cause alkaline [[caustic eye exposure]], [[conjunctivitis]] | |||
*Skin irritation - 0.5% | *Skin irritation - 0.5% | ||
**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 | ||
| Line 31: | Line 40: | ||
**[[TCA toxicity]] | **[[TCA toxicity]] | ||
*[[Malignant Hyperthermia]] | *[[Malignant Hyperthermia]] | ||
** | **anesthetics | ||
*[[Neuroleptic Malignant Syndrome]] | *[[Neuroleptic Malignant Syndrome]] | ||
** | **[[Phenothiazines]], [[Lithium]], LevoDopa | ||
===Hypothermia=== | ===[[Hypothermia]]=== | ||
*Exposure | *Exposure | ||
**[[Ethanol Toxicity]] | **[[Ethanol Toxicity]] | ||
**Sedative | **[[Sedative/Hypnotics]] | ||
**[[Opioids]] | **[[Opioids]] | ||
**[[TCAs]] | **[[TCAs]] | ||
**Phenothiazines | **[[Phenothiazines]] | ||
**[[Insulin]] ([[Hypoglycemia]]) | **[[Insulin]] ([[Hypoglycemia]]) | ||
| Line 47: | Line 56: | ||
*Direct Stimulation | *Direct Stimulation | ||
**[[Aspirin (Salicylate) Toxicity]] | **[[Aspirin (Salicylate) Toxicity]] | ||
**[[Metabolic | **[[Metabolic acidosis]] | ||
**dintirophenol, pentachlorophenol | **dintirophenol, pentachlorophenol | ||
**Hepatorenal | **[[Hepatorenal syndrome]] | ||
**CNS stimulants (cocaine, amphet, theophylline) | **CNS stimulants (cocaine, amphet, theophylline) | ||
*Tissue [[Hypoxia]] | *Tissue [[Hypoxia]] | ||
| Line 59: | Line 68: | ||
===Respiratory Depression=== | ===Respiratory Depression=== | ||
*Central Depression | *Central Depression | ||
** | **[[Antipsychotics]] | ||
**Chlorinated hydrocarbons | **Chlorinated hydrocarbons | ||
**[[Sedative/Hypnotics]] ([[Ethanol Toxicity]], glycols) | **[[Sedative/Hypnotics]] ([[Ethanol Toxicity]], glycols) | ||
**[[Tricyclic (TCA) Toxicity]] | **[[Tricyclic (TCA) Toxicity]] | ||
** | **[[Lomotil toxicity|Lomotil]] | ||
*Muscle Failure | *Muscle Failure | ||
**[[Organophosphates]] | **[[Organophosphates]] | ||
**[[Marine Toxins]] | **[[Marine Toxins]] | ||
**[[Nicotine Poisoning|Nicotine]] | **[[Nicotine Poisoning|Nicotine]] | ||
** | **[[Strychnine]] | ||
** | **[[Botulism]] | ||
**Mojave rattlesnake, | **Mojave [[rattlesnake]], cobra | ||
==Evaluation== | ==Evaluation== | ||
* | *BMP | ||
* | *[[VBG]]/[[lactate]] | ||
* | **[[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> | ||
*Assess for | *[[CXR]] if respiratory complaints | ||
**May be delayed [[pneumonitis]] | |||
*Assess for co-ingestions if there is sufficient concern | |||
==Management== | ==Management== | ||
| Line 82: | Line 94: | ||
**Consider intubation for significant respiratory compromise | **Consider intubation for significant respiratory compromise | ||
*Decontamination/eye irrigation if external exposure | *Decontamination/eye irrigation if external exposure | ||
*[[ | **Irrigate eye until pH neutralizes | ||
*Correct electrolyte | **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 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]
- No effects - 24%
- Vomiting - 66%
- Respiratory complaints (cough, stridor, SOB, pneumonitis, respiratory depression) - 16%
- Altered mental status - 9%
- Can be profound
- Eye irritation - 8%
- Cause alkaline caustic eye exposure, conjunctivitis
- Skin irritation - 0.5%
- 2nd/3rd degree chemical burns described[3]
- Fever - 0.6%
- Red flag findings (indicate potential need for endoscopy, risk of perforation)- stridor, excessive drooling, persistent vomiting
Differential Diagnosis
Hyperthermia
- Altered Metabolism
- Aspirin (Salicylate) Toxicity
- Benzo or alcohol withdrawal
- Thyroid storm
- dinitrophenols
- Increased Muscle Activity
- Sympathomimetic toxicity, alcohol withdrawal
- MAOI Toxicity
- Phencyclidine, LSD
- Lithium toxicity
- Amoxapine
- Serotonin Syndrome
- Impaired Heat Dissipation
- Malignant Hyperthermia
- anesthetics
- Neuroleptic Malignant Syndrome
- Phenothiazines, Lithium, LevoDopa
Hypothermia
Increased Respiratory Rate
- Direct Stimulation
- Aspirin (Salicylate) Toxicity
- Metabolic acidosis
- dintirophenol, pentachlorophenol
- Hepatorenal syndrome
- CNS stimulants (cocaine, amphet, theophylline)
- Tissue Hypoxia
Respiratory Depression
- Central Depression
- Antipsychotics
- Chlorinated hydrocarbons
- Sedative/Hypnotics (Ethanol Toxicity, glycols)
- Tricyclic (TCA) Toxicity
- Lomotil
- Muscle Failure
- Organophosphates
- Marine Toxins
- Nicotine
- Strychnine
- Botulism
- Mojave rattlesnake, cobra
Evaluation
- BMP
- VBG/lactate
- Lactic acidosis reported[4]
- CXR if respiratory complaints
- May be delayed pneumonitis
- Assess for co-ingestions if there is sufficient concern
Management
- ABCs
- Consider intubation for significant respiratory compromise
- Decontamination/eye irrigation if external exposure
- Irrigate eye until pH neutralizes
- Fluorescein exam for corneal defects
- 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
- ↑ 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.
- ↑ Valdez, A et al. Pediatric Exposure to Laundry Detergent Pods. Pediatrics. 2014. http://media.kshb.com/pdf/Pediatric%20Exposure%20to%20Laundry%20Detergent%20Pods.pdf
- ↑ 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
- ↑ Schneir AB, Rentmeester L, Clark RF, Cantrell FL. Toxicity following laundry detergent pod ingestion. Pediatric Emergency Care, 2013 Jun 1; 29(6): 741–2.