Poisoning and Ingestion of

Household Products
Household products are the second most common cause of
child poisoning; mostly in children aged 1-3
What is it?

Symptoms

Bleach - Mixture of
sodium
hypochlorite,
sodium
peroxide,
sodium
perborate
- The most
commonly
ingested
household
product but not
usually in
significant
quantities due
to taste

- >5mL/kg can
lead to corrosive
damage when it
comes into
contact with
mucosal
surfaces
coagulative
necrosis
- N&V&D

Alkalis - Lye
- Ammonia
- Dishwasher
powder and
detergents
- Laundry
powder and
detergents
- Oven cleaners
- Drain cleaners
- Toilet bowl
products
- Baking soda
- Soaps

- GI
ulceration/burns
if pH >11.5,
especially at the
oesophagus
- Pain, N&V,
refusing to eat
and drink,
drooling,
dysphagia
- Stridor and
respiratory
distress
- If consumed in
LARGE
quantities (very
rare due to
taste) can lead
to circulatory
collapse and
rapid onset

Management of
Ingestion
- Encourage fluids
especially milk
- Admit if symptomatic
for endoscopy

Other Issues

- Check substance, call

Poisons information
centre determine
whether it is weak,
strong, irritant or
corrosive in nature
- Wash any product
around lips etc.
Asymptomatic
- Fluid dilution
(10ml/kg) of water to a
maximum of 250ml
- Observe for 4 hours
Symptomatic
- Surgical registrar for
endoscopy
- NO ACTIVATED
CHARCOAL/GASTRIC
EMPTYING

- Most ingestion is
minimal as they do
not taste good
- Three main
groups of
detergents:
(1) Non-ionic: low
toxicity
(2) Anionic: low
toxicity
(3) Cationic: can
have corrosive
effects
- Laundry powder
is a mixture of
enzymes,
perfumes,
softeners and
anionic and nonionic detergents. It
is

- Inhalation of
bleach can
aggravate asthma
- It can also cause
skin and eye
irritation
- Mixing bleach
with other
chemicals can
create a toxic gas
(especially with
ammonia)

hypotension
- Can cause
rapid liquefactve
necrosis

Acids

- Vinegar
- Some drain
cleaners
- Some brick
and concerete
cleaners

Coagulative
necrosis, affect
the stomach
more than the
oesophagus.

As per alkalis

Sx are usually as
per Alkalis

Hydro
carbo
ns

- Mineral
turpentine
- Pine oil
- White spirits
- Furniture
polishes
- (Kerosene,
petrol, lighter
fluid, diesel)

Essent - Tea tree oil

ial
- Aromatherapy
Oils
oils
- Eucalyptus
oils

- Aspiration
pneumonitis:
coughing,
choking,
respiratory
distress
- CNS toxicity:
depression or
excitement:
ataxia,
drowsiness,
coma,
convulsions
- Persistent
burping
- Coughing
- Choking
- Respiratory
distress
- Confusion
- Drowsiness
- Coma
- Convulsions
- N&V
- Hypotension
- Tachycardia
- Usually rapid

- Keep NBM
Asymptomatic
- Observe 6 hours
- F/U one day later
Symptomatic
- Respiratory Sx: CXR
and O2 sat, O2 to main
>94%
- ICU if requiring
increased O2 or if
altered conscious state
- NO ACTIVATED
CHARCOAL
Asymptomatic
- Nil specific treatment
- Observe for 4/24
Symptomatic
- Respiratory Sx: CXR
and O2 saturation for
aspiration pneumonitis
- Observe for symptom
progression
- If deteriorating, ICU
- NO ACTIVATED
CHARCOAL

usually low
toxicity, nil specific
treatment
- Ammonia
dissolves in water
to form ammonium
hydroxide, a
caustic solution
and weak base
- Gastric emptying:
reexposes upper
GIT to product
- Neutralising with
a basic substance
can lead to severe
exothermic
reactions
- Activate charcoal
can infiltrate
burned
tissue/interfere
with endoscopy
- Highest risk is in
phenol based
derivatives e.g.
chloroxyeol (in
Dettol)

Small ingestions
can cause severe
symptoms

Rat
Bait

- Most are
based on
warfarin or
alphachlorlos
e (chloral
derivative)

onset, can be
delayed up to 4
hours
- Anticoagulants
have no
immediate
effects
Alphachloralose
can cause CNS
depression

- Measure PT time if >

0.5mg/kg of warfarin or
0.01mg/kg any other
anticoagulant has been
consumed
- Alphachloralose: if
>2g has been ingested,
give activated charcoal
- Observe for four hours
- If unsure of active
ingredient, treat for
both

References
http://adc.bmj.com/content/87/5/403.full
http://coeh.berkeley.edu/ucpehsu/Resources/EHECEP/GreenC
leaningToolkitHandouts/FactSheet_Bleach.pdf
http://www.rch.org.au/clinicalguide/guideline_index/Eucalypt
us_Oil_and_Essential_Oils_Poisoning/
http://www.rch.org.au/clinicalguide/guideline_index/Alkalis_P
oisoning/
http://www.nlm.nih.gov/medlineplus/ency/article/002777.ht
m
http://pediatrics.aappublications.org/content/126/3/509.full
http://www.merckmanuals.com/professional/injuriespoisoning/poisoning/caustic-ingestion