Diferencia entre revisiones de «Laundry detergent pod ingestion»
Sin resumen de edición |
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| Línea 8: | Línea 8: | ||
*No effects - 24% | *No effects - 24% | ||
*[[Vomiting]] - 66% | *[[Vomiting]] - 66% | ||
*Respiratory complaints ([[cough]], [[stridor]], [[SOB]]) - 16% | *Respiratory complaints ([[cough]], [[stridor]], [[SOB]], [[pneumonitis]], [[respiratory failure|respiratory depression]]) - 16% | ||
*[[Altered mental status]] - 9% | *[[Altered mental status]] - 9% | ||
**Can be profound | |||
*Eye irritation - 8% | *Eye irritation - 8% | ||
**Cause alkaline [[caustic eye injury]], [[conjunctivitis]] | |||
*Skin irritation - 0.5% | *Skin irritation - 0.5% | ||
**2nd/3rd degree [[chemical burns]] described<ref>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</ref> | |||
*[[Fever]] - 0.6% | *[[Fever]] - 0.6% | ||
| Línea 77: | Línea 80: | ||
==Evaluation== | ==Evaluation== | ||
* | *BMP | ||
*[[VBG]]/[[lactate]] | |||
**[[Lactic acidosis]] reported<ref>Schneir AB, Rentmeester L, Clark RF, Cantrell FL. Toxicity following laundry detergent pod ingestion. Pediatric Emergency Care, 2013 Jun 1; 29(6): 741–2.</ref> | |||
*[[CXR]] if respiratory complaints | *[[CXR]] if respiratory complaints | ||
**May be delayed [[pneumonitis]] | **May be delayed [[pneumonitis]] | ||
| Línea 87: | Línea 92: | ||
**Consider intubation for significant respiratory compromise | **Consider intubation for significant respiratory compromise | ||
*Decontamination/eye irrigation if external exposure | *Decontamination/eye irrigation if external exposure | ||
*[[ | **Irrigate eye until pH neutralizes | ||
**Fluorescein exam for [[corneal abrasion|corneal defects]] | |||
*[[Antiemetics]] for nausea | |||
*Correct electrolyte abnormalities if present | *Correct electrolyte abnormalities if present | ||
*Contact Poison Control | *Contact Poison Control | ||
Revisión del 16:34 26 ago 2019
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 injury, 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.