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Rocka A, Piędel F, Madras D, Krawiec P, Pac-Kożuchowska E. Dark side of laundry pods: Analysis of exposure to laundry detergent capsules in children. J Paediatr Child Health 2021; 57:1912-1916. [PMID: 34129255 DOI: 10.1111/jpc.15608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 12/01/2022]
Abstract
AIM We aimed to evaluate the epidemiological characteristic and clinical features of laundry detergent capsule (LDC) exposure in children. METHODS Retrospective review of medical records of patients hospitalised due to the exposure to LDC at the Department of Paediatrics and Gastroenterology, Medical University of Lublin, Poland, from 2014 to 2019 was conducted. RESULTS During the study period, 38 children including 19 (50%) boys and 19 (50%) girls were admitted to our department due to exposure to LDC. The age of patients ranged from 11 months to 9 years, with a mean 48.61 ± 28.85 months of age. About 66% of patients were younger than 5 years. The major route of exposure was ingestion (n = 37; 97%). Most patients (n = 27; 71%) exhibited symptoms of exposure to the LDC. The most common symptoms were vomiting (n = 23; 60%), cough (n = 7; 18%) and salivation (n = 5; 13%). Seven patients required gastroscopy. Abnormalities were subsequently identified in three children. CONCLUSIONS Accidental exposure to LDC usually occurs in children younger than 5 years. Although the majority of cases had mild or moderate clinical outcomes, ingestion of LDC may lead to some severe consequences. Improvements in parental education regarding the risks of LDC, and in the packaging of LDC may prevent serious injury.
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Affiliation(s)
- Agata Rocka
- Students' Scientific Group at the Department of Paediatrics and Gastroenterology, Medical University of Lublin, Lublin, Poland
| | - Faustyna Piędel
- Students' Scientific Group at the Department of Paediatrics and Gastroenterology, Medical University of Lublin, Lublin, Poland
| | - Dominika Madras
- Students' Scientific Group at the Department of Paediatrics and Gastroenterology, Medical University of Lublin, Lublin, Poland
| | - Paulina Krawiec
- Department of Paediatrics and Gastroenterology, Medical University of Lublin, Lublin, Poland
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Reynolds KM, Burnham RI, Delva-Clark H, Green JL, Dart RC. Impact of product safety changes on accidental exposures to liquid laundry packets in children. Clin Toxicol (Phila) 2020; 59:392-399. [PMID: 32960108 DOI: 10.1080/15563650.2020.1817478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the impact of the ASTM International (formerly American Society of Testing Materials) safety standard and associated product safety changes on accidental exposures to liquid laundry packets (LLPs) in children. METHODS The National Poison Data System was queried for reports of accidental exposures to LLPs in children <6 years old received from 01 July 2012 to 31 December 2018. In 2014, ASTM International began developing a standard specifying voluntary product changes to reduce the risk of LLP exposures in young children. Product changes were made between 2013 and 2016. Exposures were grouped into baseline, transition, and post periods based on the timing of the standard's implementation. Exposure counts and sales adjusted rates were compared between the baseline and post period for all exposures and exposures involving healthcare facility (HCF) evaluation, HCF admission, and major medical outcomes. RESULTS A total of 73,942 accidental exposures in children <6 years old were reported (baseline: 10,229, 13.8%; transition: 43,507, 58.8%; post: 20,206, 27.3%). The percentage of exposures involving HCF evaluation (41.5% to 33.8%), HCF admission (4.5% to 1.9%), and major medical outcomes (0.6% to 0.1%) decreased from the baseline to post period. Sales adjusted rates of all exposures decreased 57.4% (4.920-2.094 exposures/1 million packets sold). Decreases also occurred in HCF evaluations (65.0% decrease; 2.026-0.708 exposures/1 million packets sold), HCF admissions (81.4% decrease; 0.218-0.041 exposures/1 million packets sold), and major medical outcomes (90.9% decrease; 0.030-0.003 exposures/1 million packets sold). CONCLUSIONS The morbidity of accidental exposures to LLPs in children decreased substantially following implementation of the ASTM International safety standard. Ongoing monitoring should be performed to determine if additional safety measures are required.
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Affiliation(s)
- Kate M Reynolds
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
| | - Randy I Burnham
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
| | - Heather Delva-Clark
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
| | - Jody L Green
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA.,Inflexxion, an IBH Company, Costa Mesa, CA, USA
| | - Richard C Dart
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
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Banner W, Yin S, Burns MM, Lucas R, Reynolds KM, Green JL. Clinical characteristics of exposures to liquid laundry detergent packets. Hum Exp Toxicol 2019; 39:95-110. [PMID: 31578092 DOI: 10.1177/0960327119874451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Our objective was to describe the characteristics of liquid laundry detergent packet (LDP) exposures and to develop referral and treatment recommendations. METHODS This retrospective cohort study investigated LDP exposures reported to the National Poison Data System from January 1, 2013 through June 30, 2014. Three medical toxicologists reviewed the most significant exposures (n = 450). RESULTS Of 17,857 reported LDP exposures, 13,307 involved only an LDP (no other substance) and were followed to a known medical outcome. The median age was 2 years (range 12 days to 100 years). Approximately 10% of exposures reported a major or moderate effect. The most common symptom was vomiting (51.7%; n = 6875), but stridor or aspiration pneumonia and respiratory depression secondary to central nervous system effects also occurred. Two pediatric and two adult deaths occurred, but no causal mechanism leading to death could be identified in any of the deaths. CONCLUSIONS LDPs occasionally produce a toxidrome of vomiting, stridor, hypoxia, and sedation with metabolic acidosis and respiratory failure. These symptoms and the availability of LDPs highlight the need for referral and treatment recommendations and efforts to minimize unintentional exposures. Review of data from US poison centers may provide referral and treatment recommendations that improve patient outcomes.
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Affiliation(s)
- W Banner
- Oklahoma Center for Poison and Drug Information, Oklahoma University College of Pharmacy, Oklahoma City, OK, USA
| | - S Yin
- Drug & Poison Information Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - M M Burns
- Harvard Medical School, Boston, MA, USA
| | - R Lucas
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
| | - K M Reynolds
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
| | - J L Green
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA.,Inflexxion, an IBH Company, Costa Mesa, CA, USA
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Day R, Bradberry SM, Thomas SHL, Vale JA. Liquid laundry detergent capsules (PODS): a review of their composition and mechanisms of toxicity, and of the circumstances, routes, features, and management of exposure. Clin Toxicol (Phila) 2019; 57:1053-1063. [DOI: 10.1080/15563650.2019.1618466] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Yin S, Colvin J, Behrman A. Single-Use Laundry Detergent Pack Exposures in Children Under 6 Years: A Prospective Study at U.S. Poison Control Centers. J Emerg Med 2018; 55:354-365. [DOI: 10.1016/j.jemermed.2018.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/10/2018] [Accepted: 05/30/2018] [Indexed: 10/28/2022]
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Abstract
Ingestion of laundry detergent packets is an important threat to young children. Because of their developmental stage, toddlers are prone to place these small, colorful packets in their mouths. The packets can easily burst, sending a large volume of viscous, alkaline liquid throughout the oropharynx. Ingestion causes major toxic effects, including depression of the central nervous system, metabolic acidosis, respiratory distress, and dysphagia. Critical care nurses should anticipate these clinical effects and facilitate prompt intervention. Increased understanding of the risks and clinical effects of ingestion of laundry detergent packets will better prepare critical care nurses to provide care for these children. (Critical Care Nurse 2016; 36[4]:70-75).
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Affiliation(s)
- Lindsey Wilson Shah
- Lindsey Wilson Shah is a recent graduate of the pediatric critical care nurse practitioner program at the University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania. She currently works in the pediatric intensive care unit at Texas Children's Hospital in Houston, Texas.
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Settimi L, Giordano F, Lauria L, Celentano A, Sesana F, Davanzo F. Surveillance of paediatric exposures to liquid laundry detergent pods in Italy. Inj Prev 2017; 24:5-11. [PMID: 28188147 PMCID: PMC5800340 DOI: 10.1136/injuryprev-2016-042263] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/11/2017] [Accepted: 01/18/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To analyse paediatric exposures to pod and traditional laundry detergents in Italy and changes in exposure trends. METHODS Analyses of a series of patients aged <5 years and exposed to laundry detergents between September 2010 and June 2015, identified by the National Poison Control in Milan. RESULTS In comparison with patients exposed to traditional laundry detergents (n=1150), a higher proportion of those exposed to pods (n=1649) were managed in hospital (68% vs 42%), had clinical effects (75% vs 22%) and moderate/high severity outcomes (13% vs <1%). Exposure rates were stable over time for traditional detergents (average 0.65 cases/day), but an abrupt decline in major company pods was seen in December 2012, 4 months after the introduction of opaque outer packaging (from 1.03 to 0.36 cases/day and from 1.88 to 0.86 cases/million units sold). The odds of clinical effects was higher for exposure to pods than for traditional detergents (OR=10.8; 95% CI 9.0 to 12.9). Among patients exposed to pods, the odds of moderate/high severity outcomes was four times higher for children aged <1 years than for the other age groups (OR=3.9; 95% CI 2.2 to 7.0). Ten children exposed to laundry detergent pods had high severity outcomes while no children exposed to traditional laundry detergents developed high severity effects. CONCLUSIONS The study confirms that exposure to laundry detergent pods is more dangerous than exposure to traditional detergents. In Italy, 4 months after the introduction of opaque outer packaging by a major company, product-specific exposure rates decreased sharply, suggesting that reducing visibility of laundry detergent pods may be an effective preventive measure. Further efforts are needed to improve safety.
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Affiliation(s)
- Laura Settimi
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
| | - Felice Giordano
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Laura Lauria
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
| | - Anna Celentano
- National Poison Control Center in Milan, Niguarda Cà Granda Hospital, Milan, Italy
| | - Fabrizio Sesana
- National Poison Control Center in Milan, Niguarda Cà Granda Hospital, Milan, Italy
| | - Franca Davanzo
- National Poison Control Center in Milan, Niguarda Cà Granda Hospital, Milan, Italy
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