Laundry detergent pod ingestion
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.