Common Household Poisoning Nur Afni Amir Drug & Poison Information Pharmacist National Poison Centre, USM
TOPIC OUTLINE At the end of this lecture, you should be able to answer these question… What are common household poisoning? Which household item is dangerous? What are the sign and symptoms of the poisoning? What are the treatment ? What can you do to avoid accidental household poisoning?
What are common household poisoning? • Detergents (bleaching agents, floor cleaner,laundry detergents) • Solvents (kerosene, thinner) • Automotive products (petrol,brake fluid,battery water) • Cosmetics and personal care (soaps,shampoo,nail polish) • Other household product (mothball,dessicant)
HOUSEHOLD BLEACHES 1 . Chlorine based bleaches - contain chlorine or hypochlorite - general disinfectant and bleaching agent. - The toxicity of bleach is related primarily to the oxidizing capacity of the hypochlorite ion and the pH of the solution 2. Non-chlorine bleaches - used in numerous household products, including disinfectants, chlorine free bleaches, fabric stain removers, contact lens disinfectants, hair dyes and tooth whitening products - May contain hydrogen peroxide, sodium perborate, sodium percarbonate
HOUSEHOLD BLEACHES: CHLORINE BASED 1. Most household bleach solutions contain 3% - 5%hypochlorite. *swimming pool disinfectants &industrial bleach : up to 20% hypochlorite 2. Bleaches with a hypochlorite concentration greater than 10% are corrosive while those with a concentration of less than 10% are irritants (Kiristioglu et al, 1999). 3.Household bleach is a mild to moderate irritant which does not cause tissue damage unless ingested in large amounts. Systemic toxicity may occur after a large ingestion. 4.Ingestion of more than 100 mL in a child or 300 mL in an adult of a household bleach (<10% sodium hypochlorite) may cause significant toxicity.
CLINICAL EFFECTS HYPOCHLORITE SEVERE *concentrated solution significant esophageal & MILD TO MODERATE gastric burns *dilute hypochlorite dysphagia, drooling, severe solutions (3%-5%) throat, chest & abdominal pain. immediate burning in the hematemesis & GI mouth & throat. perforation systemic toxicity:electrolyte GI upset disturbances, metabolic no further injury acidosis, mental status changes, cardiovascular effects and pulmonary edema
HOUSEHOLD BLEACHES Hypochlorite + Ammonia = chloramine gas Hypochlorite + Acid (Toilet bowl /tile cleaner) = Chlorine gas
HOUSEHOLD BLEACHES: CLINICAL EFFECTS INHALATION OF CHLORAMINE /CHLORINE GAS • With normal use, household bleach is NOT a respiratory hazard • Corrosive gases may be produced when mixing bleach with other household cleaning products • IRRITANT effects on the mucous membrane (eyes,nose,throat) • May trigger wheezing and respiratory symptoms • In serious exposures, which are rare with household products, upper airway edema may cause obstruction and chemical pneumonitis may also occur.
HOUSEHOLD BLEACHES TREATMENT INGESTION • Treatment is unlikely to be required if only small amounts have been ingested • Gastric lavage should NOT be undertaken : risk of aspiration • Activated charcoal is CONTRAINDICATED • Neutralization is CONTRAINDICATED : Administration of acids or basic substances for neutralization is contraindicated due to the possibility of exothermic reaction and subsequent burning. • Dilution :small amount of milk or water as soon as possible after ingestion. The ideal amount is unknown; no more than 8 ounces (240 mL) in adults and 4 ounces (120 mL) in children is recommended to minimize the risk of vomiting (Caravati, 2004).
HOUSEHOLD BLEACHES • ENDOSCOPY is indicated in a patient with any of the following: drooling, pain, dysphagia, evidence of oropharyngeal burns a history of intentional ingestion of a substantial amount of corrosive material.
HOUSEHOLD BLEACHES TREATMENT INHALATION EXPOSURE Leave the area of exposure immediately Supplemental oxygen, bronchodilators,and advanced airway support(eg, intubation) as necessary EYE EXPOSURE Immediate copious eye irrigation DERMAL EXPOSURE Remove all exposed clothing and wash exposed areas of the body twice with water. Standard burn care (eg, dressings, antibiotic ointment) for corrosive injuries. Wash all exposed clothes with soap and water. Complications are unlikely.
HOUSEHOLD BLEACHES: HYDROGEN PEROXIDE Colourless, odourless, acidic oxidizing agent available in a variety of concentrations from 3 to 90% General purpose disinfectants 3% Hair bleach and hair dyes 6% Contact lens disinfectants 3% Chlorine free bleach 6% Fabric stain removers 5-15% Industrial strength up to 90%
HOUSEHOLD BLEACHES: HYDROGEN PEROXIDE MILD TO MODERATE TOXICITY INGESTION INHALATION & OCULAR vomiting, household strength mild gastrointestinal hydrogen peroxide irritation (3%) can cause respiratory gastric distension irritation and mild ocular gastrointestinal erosions irritation Hydrogen peroxide's toxicity is mainly due to the release of oxygen gas causing venous or arterial gas embolism. Each mL of 3% hydrogen peroxide releases 10 mL of oxygen gas
HOUSEHOLD BLEACHES: HYDROGEN PEROXIDE SEVERE TOXICITY INGESTION: INHALATION: Inhalation of vapors from Ingestion of higher (greater than 10%) concentrated (greater than 10%) concentration products. solutions may result in severe caustic injuries to the gastrointestinal pulmonary irritation. tract, leading to hemorrhagic gastritis, Acute lung injury and respiratory burns in the mouth, throat, esophagus, arrest and stomach, ulcerating colitis, intestinal gangrene, and gas OCULAR: embolization. Eye exposure to high Systemic gas embolization can involve concentrations can cause corneal any organ, resulting in seizure, cerebral ulceration and perforation. infarction, cerebral edema, spinal cord infarction, acute myocardial infarction, DERMAL: hypotension, cardiac arrest, and death. Dermal exposure to concentrated solutions has resulted in burns and gangrene
DETERGENTS Used in many cleaning products. Mainly contain surface active agents consist of: ANIONIC, NONIONIC CATIONIC Mildly irritating Hazardous
DETERGENTS Anionic Surfactant Nonionic Surfactant Cationic Surfactant Most common Common in heavy Disinfectants,industrial products, fabric surfactant in duty laundry softener,swimming pool algicides bath soap,shampoo, detergent • benzalkonium /benzethonium general laundry • Alkylpolyethoxylates chlorides detergents • Chlorhexidine • cetylpyridinium,cetrimonium • Alkyl sulfate • gluconate dequalinium chloride • Ethoxylated alcohols • Alkyl sulfonates • 10-15% : caustic • Alkyl phosphate • Lauramide DEA • 0.1-0.5% : significant mucosal irritation • Alkylbenzene sulfonates • Nonoxynol • Esophageal or gastrointestinal tract • PEG alkyl aryl ethers • Ammonium lauryl burns are possible with ingestion of • PEG stearates sulfate just a few mL of concentrated solution. • Polysorbate 60 • Sodium lauryl sulfate • CNS depression progressing to coma • Sodium stearate • Polysorbate 20 and shock (rare) • Polyethylene glycol Irritants effect Produce less local irritation than anionic
DETERGENTS • Proteolytic/amylolytic enzymes used in laundry detergents and presoaks to loosen soil & remove stain • Products contain enzyme,detergents and builders which have irritating and sensitizing properties • Ingestion: likely to cause emesis
DETERGENTS: CLINICAL EFFECTS ORAL INGESTION: - Immediate spontaneous vomiting - Intractable vomiting, diarrhea & hematemesis with large ingestion EYE EXPOSURE: - Mild to serious corrosive injury depending on products SKIN EXPOSURE: - Mild erythema or rash
DETERGENTS:TREATMENT DECONTAMINATION Dilution Do NOT induce emesis Activated charcoal CONTRAINDICATED Irrigation with copious amount of water in cases of eye exposure EMERGENCY/SUPPORTIVE MEASURES IV fluids to correct dehydration and electrolyte imbalance due to protracted vomiting or diarrhea MONITORING Most exposures do not require specific testing Endoscopy:within 24 hours in patients whom GI burns are a concern (patients with stridor, drooling of saliva,dysphagia, or severe throat and abdominal pain)
CAUSTIC & CORROSIVES AGENTS THESE ARE CHEMICALS THAT IRRITATE, BURN OR DAMAGE SKIN AND OTHER LIVING CELLS. Consists of: • Mineral and organic acids • Alkalis
EXAMPLES OF ACIDS CORROSIVE (DANGER) STRONG IRRITANTS WEAK IRRITANTS Acetic acid>/=50% Acetic acid 10-50% Glycolic acid >10% Boric acid Acetic acid 5-10% Hydrochloric acid >10% Hydrochloric acid 5-10% Aluminium sulfate 5-20% Oxalic acid >10% Oxalic acid <10% Hydrochloric acid <5% Phosphoric acid >60% Phosphoric acid 35-60% Phosporic acid 15-35% Sulfuric acid >10% Sulfuric acid <10 % Zinc sulfate >50% Zinc sulfate 5-50%
PRODUCTS CONTAINING ACIDS Automobile battery - Sulphuric acid 25-30% Toilet Bowl Cleaner (liquid) - Hydrochloric acid 10-25% - Sulfuric acid 80% Toilet Bowl Cleaner (granular) - sodium bisulphate 70-100% Metal cleaners and antirust - Phosphoric acid 5-80% - Oxalic acid 1% - Hydrochloric acid 5-25% - Chromic acid 5-20% Drain cleaners - Sulfuric acid 95-99%
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