Airway edema following household bleach ingestion

Multiorgan failure and death from a mixed Dettol and Clorox poisoning: a case report

BACKGROUND

Dettol and sodium hypochlorite have wide use as household disinfectants and cleaners. Intentional and nonintentional ingestion are widespread, mainly causing mild symptoms that require no specific treatment. However, severe complications can occur when large volumes are ingested. Both products affect the same organ systems in the body, which can result in fatalities when ingested together.

CASE PRESENTATION

We present the case of a 26-year-old Asian man who died from multiorgan failure after deliberately ingesting a presumed large volume of Dettol and sodium hypochlorite. The case illustrates the severe complications that can occur with mixed ingestion of these commonly used household products.

CONCLUSION

Clinicians must be aware of the increased risk of death caused by the combined ingestion of chloroxylenol and sodium hypochlorite.

Koroziv Madde Alımı Olan Çocukların Uzun Dönem Akciğer Kapasitelerinin Spirometri ile Değerlendirilmesi

Amaç: Bu çalışmada korozif madde alımı sonucu özofagus striktürü gelişen ve mükerrer defa özofagus dilatasyonu işlemi yapılan hastaların uzun dönem akciğer durumlarının spirometri ile değerlendirilmesi amaçlanmıştır. Yöntem: Ocak 2014– Mayıs 2021 tarihleri arasında merkezimize KMA nedeniyle başvuran hastalar retrospektif olarak incelendi. Hastalar; Group 1: Kontrol grubu (n=23) Group 2: Korozif madde alımı sonrası dilatasyon işlemine ihtiyacı olmayan ve kür sağlanmış hastalar (n=9) Grup 3: Korozif madde alımına bağlı özofagus striktürü gelişen ve genel anestezi altında dilatsyon işlemi uygulanan hastalar (n=9) olarak üç gruba ayrıldı. Değerlendirme için; 1. Saniyedeki zorlu ekspiratuar akım hızı (FEV1), zorlu vital kapasite (FVC), FEV1/FVC ve zorlu ekspirasyon ortası akım hızı (FEF 25-75) parametreleri kaydedildi. Bulgular: Yapılan istatistik analizi sonuçlarına göre FEV1, FVC ve FEF 25-75 gibi değerlerin üzerinde dilatasyon işleminin etkisi incelendiğinde Grup 1-2 için FEV1 (p=0,02) ve FVC (p =0,01) değerleri arasındaki fark istatistiksel olarak anlamı, grup1-3 ve grup 2-3 arasında anlamsız (p>0,05) saptandı. FEV1/FVC (p>0,05) ve FEF 25-75 (p>0,05) arasında hiçbir grupta anlamlı fark saptanmadı. Sonuç: Hastalarımızın spirometre ile değerlendirilen akciğer kapasitelerinde uzun dönem olumsuz bir etkilenme tespit edilememiştir.

Acute accidental inhalation of Chlorine gas: A mini review

The Authors report an accidental gas exposure of Chlorine gas in a worker. This accident is very uncommon and can lead to important life-threatening conditions, such as Reactive Airway Disfunction Syndrome (RADS) and Acute Respiratory Distress Syndrome (ARDS) with important pulmonary disfunctions and even death. This syndrome results are reversible when a quick and appropriate intensive treatment is performed.

Caustic Ingestion in Children: a Systematic Review and Meta-Analysis

Introduction: Caustic ingestion that occurs accidently is one of the most common problems in children. Methods: This systematic review has been performed by searching the databases including Science Direct, ProQuest, Google Scholar, and PubMed. A strategic search was performed with keywords including caustic, corrosive, ingestion, and children, and was limited to articles in English and Persian. Data were analyzed using Comprehensive Meta-Analysis2 and PASW Statistics 18. Results: We selected 64 articles regarding caustic ingestion with a total sample of 11,345 cases. The data analysis indicated a higher consumption in young boys (age range 2.78 (2.02) years (OR=0.53 with a 95% confidence interval of 0.49-0.57 (P=0.08)). The most common caustic substances were household cleaning agents, particularly bleaches and cleaners. Esophageal cancer and death were reported as well as digestive and respiratory complications. Invasive and expensive techniques are frequently used for diagnosis, treatment and follow up. Conclusion: The results demonstrated that although caustic ingestion is a serious problem among children, it is a preventable and manageable issue. Therefore, appropriate efforts by families, government, factories, health team and media should be made to handle adequately this matter.

Toxico-pathological effects of sodium hypochlorite administration through drinking water in female Japanese quail (Coturnix japonica)

Fifty female Japanese quail (Coturnix japonica) at 40 days were divided into five equal groups. Sodium hypochlorite was added in drinking water to provide 0, 25, 50, 200, 400 mg chlorine/L for 6 weeks. At week 7, the chlorine concentration of 25 and 50 mg groups was increased to 100 mg and further increased to 400, 1600 and 6400 mg at weeks 8, 9 and 10, respectively. At the end the experiment (week 10), all the birds were sacrificed. No clinical signs were observed in quail given 50 mg chlorine/L. Quail given 200-400 mg/L chlorine exhibited decreased feed intake, body weight and egg production. In addition, those given 1600-6400 mg/L chlorine also exhibited depression. Decreased hematocrit, erythrocyte, hemoglobin, leukocytes, plasma proteins and globulin were observed at 200 mg/L chlorine and higher concentration. Gross lesions were not observed in quail offered 200-400 mg/L chlorine for 6 weeks; however, those offered 1600-6400 mg/L chlorine exhibited atrophied pectoral muscles, prominently protruding keel bones, decreased weight of ovary and oviduct and a reduction in an area of the different segments of oviduct. The histopathological picture in mucosa of oviduct consisted of degenerated glandular cells. In some cases, glandular tissue was replaced by cord of cells and fibroblast. The present study suggested that sodium hypochlorite in drinking water yielding 50 mg/L chlorine was not toxic for 6 weeks. However, sodium hypochlorite providing 200 mg/L chlorine or higher concentrations in drinking water was toxic to the quail.

Serious injuries from dishwasher powder ingestions in small children

AIMS

To describe patterns and severity of caustic injuries sustained from dishwasher powder ingestion and highlight need for national safety standards.

METHODS

Retrospective chart review of admissions for caustic ingestion to Starship Children's Hospital from January 2003 to January 2005 and review of New Zealand National Poisons Centre data.

RESULTS

Between January 2003 and January 2005, the National Poisons Centre recorded 610 dishwashing powder ingestions, with 88% of children less than 2 years old. Twenty-three children were admitted to Starship Children's Hospital following caustic ingestion, of whom 11 were identified as having ingested dishwasher powder (9 boys and 2 girls) and were aged 11 to 30 months (mean 17.5). Five children (45%) were admitted to the Paediatric Intensive Care Unit over 4 months (October 2004 to January 2005), requiring intubation for airway control. Two children needed tracheostomy. Three of the 11 children (27%) required repeated oesophageal dilatation, and two underwent gastrostomy formation. One brand of dishwasher detergent and container type was implicated in over half of the cases.

CONCLUSIONS

Dishwasher detergents are highly corrosive substances that cause potentially life-threatening injuries and ongoing morbidity. The recent surge of incidents may be related to change in product constituents or non-compliance with New Zealand safety standards. Efforts to limit product alkalinity, legislative requirement of Child-Resistant Packaging and public education may reduce injuries from these common household substances.

Respiratory and gastrointestinal complications of caustic ingestion in children

OBJECTIVES

To determine circumstances surrounding the ingestion of caustic substances, the incidence of respiratory and gastrointestinal symptoms at presentation, and the degree of investigation and active treatment during hospitalisation. Long term respiratory and gastrointestinal sequelae were also studied.

DESIGN

Retrospective case note study covering a 10 year period.

SETTING

Tertiary children's hospital.

PATIENTS

Children and adolescents presenting following caustic ingestions to the Royal Children's Hospital, Melbourne.

MAIN OUTCOME MEASURES

Requirement for interventional oesophagoscopy/bronchoscopy, respiratory support or admission to intensive care, and long term gastrointestinal or respiratory sequelae noted.

RESULTS

Thirty two cases of caustic ingestion were identified in 31 patients (median age 2.6 years; 78% boys). The average time in hospital was 2 days. Two patients (6%) required intensive care nursing, and both required intubation with mechanical ventilation (average 33 hours). Thirty patients (97%) underwent diagnostic oesophagoscopy, and two underwent laryngoscopy or bronchoscopy for visualisation of the upper airway. No patient had long term respiratory consequences. Two patients (6%) sustained significant oesophageal injuries requiring interventional oesophagoscopy.

CONCLUSIONS

Caustic ingestion is overrepresented in boys. Most ingestions involve household cleaning products. Symptoms on admission do not usually require intensive care admission. Gastrointestinal symptoms predominate at presentation, however, these are usually mild. Respiratory symptoms are uncommon and respiratory involvement requiring intervention is rare, although the presence of respiratory symptoms should be viewed as potentially serious. Long term sequelae of caustic ingestion are rare and in this series only affected the gastrointestinal tract. The indications for diagnostic endoscopy need further evaluation.