Poisoning - cleaning substances in Children

Pediatric emergencies

Clinicals - History

Fact Explanation
Cough, breathing difficulty Inhalation injuries can occur due to Hypochlorite solutions, which can liberate toxic gases such as chlorine. Chlorine's irritant properties causes cough.Throat swelling causes breathing difficulties.
Ingestion of hypochlorite solutions may lead to pulmonary
complications when the liquid is aspirated
Cough, breathing difficulty
Inhalation injuries can occur due to Hypochlorite solutions, which can liberate toxic gases such as chlorine. Chlorine's irritant properties causes cough.Throat swelling causes breathing difficulties.
Ingestion of hypochlorite solutions may lead to pulmonary
complications when the liquid is aspirated
Vomiting/ vomiting blood, abdominal pain, blood in stools Ingestion of hypochlorite solutions causes vomiting and corrosive injury to the gastrointestinal tract. This causes bleeding due to ulceration.
Household bleaches (3 to 6% sodium hypochlorite) usually cause esophageal irritation
Vomiting/ vomiting blood, abdominal pain, blood in stools
Ingestion of hypochlorite solutions causes vomiting and corrosive injury to the gastrointestinal tract. This causes bleeding due to ulceration.
Household bleaches (3 to 6% sodium hypochlorite) usually cause esophageal irritation
Loss of vision Direct contact with hypochlorite solutions, powder, or concentrated vapor causes severe chemical burns, leading to cell death and ulceration Loss of vision
Direct contact with hypochlorite solutions, powder, or concentrated vapor causes severe chemical burns, leading to cell death and ulceration
Skin burns Hypochlorite irritates the skin and can cause burning pain,
inflammation, and blisters
Skin burns
Hypochlorite irritates the skin and can cause burning pain,
inflammation, and blisters
Seizures Severe change in the acid level in the blood (pH balance), can lead to seizures.Electrolyte imbalances can also cause seizures Seizures
Severe change in the acid level in the blood (pH balance), can lead to seizures.Electrolyte imbalances can also cause seizures
Unconscious Acid base disturbances and electrolyte imbalances can lead to shock Unconscious
Acid base disturbances and electrolyte imbalances can lead to shock
Poor education level of parents Risk factor due to improper guidance and care of the children Poor education level of parents
Risk factor due to improper guidance and care of the children

Clinicals - Examination

Fact Explanation
Dyspnea Due to inhalation injury.Hypochlorite solutions can liberate toxic gases such as chlorine which causes irritation of the respiratory tract Dyspnea
Due to inhalation injury.Hypochlorite solutions can liberate toxic gases such as chlorine which causes irritation of the respiratory tract
Abdominal tenderness Ingestion of cleaning substances cause irritation of the gastro intestinal tract Abdominal tenderness
Ingestion of cleaning substances cause irritation of the gastro intestinal tract
Convulsions Severe change in the acid level in the blood (pH balance), can lead to seizures.Electrolyte imbalances can also cause seizures Convulsions
Severe change in the acid level in the blood (pH balance), can lead to seizures.Electrolyte imbalances can also cause seizures
Hypotension, tachycardia, cold peripheries Acid base disturbances and electrolyte disturbances can cause shock Hypotension, tachycardia, cold peripheries
Acid base disturbances and electrolyte disturbances can cause shock

Investigations - Diagnosis

Fact Explanation
Upper gastro intestinal tract endoscopy Direct visualization of the esophagus is of primary importance for determining the extent of injury. All patients who are suspected of having significant ingestion, or those (such as children) for whom there is an unreliable history, must have early endoscopy within 36
to 48 hours of ingestion. Use of a flexible endoscope is associated with a lower risk of perforation.
Upper gastro intestinal tract endoscopy
Direct visualization of the esophagus is of primary importance for determining the extent of injury. All patients who are suspected of having significant ingestion, or those (such as children) for whom there is an unreliable history, must have early endoscopy within 36
to 48 hours of ingestion. Use of a flexible endoscope is associated with a lower risk of perforation.
Arterial blood gas analysis Chlorine inhalation may be complicated by hyperchloremic metabolic acidosis Arterial blood gas analysis
Chlorine inhalation may be complicated by hyperchloremic metabolic acidosis

Investigations - Management

Fact Explanation
Upper gastro intestinal tract endoscopy To look for chronic complications - esophageal obstruction, pyloric
stenosis,squamous cell carcinoma of the esophagus
Upper gastro intestinal tract endoscopy
To look for chronic complications - esophageal obstruction, pyloric
stenosis,squamous cell carcinoma of the esophagus
Serum electrolytes Poisoning due to ion (eg:sodium, calcium etc) containing products can cause electrolyte imbalances Serum electrolytes
Poisoning due to ion (eg:sodium, calcium etc) containing products can cause electrolyte imbalances
Electrocardiogram To identify electrolyte imbalances which can cause arrhythmia Electrocardiogram
To identify electrolyte imbalances which can cause arrhythmia

Management - Supportive

Fact Explanation
Emergency management Quickly establish a patent airway, ensure adequate respiration and
pulse.
In cases of respiratory compromise secure airway and respiration
via endotracheal intubation.Treat patients who have bronchospasm with an aerosolized
bronchodilator.
Intra venous fluid may be required to maintain the circulation
Emergency management
Quickly establish a patent airway, ensure adequate respiration and
pulse.
In cases of respiratory compromise secure airway and respiration
via endotracheal intubation.Treat patients who have bronchospasm with an aerosolized
bronchodilator.
Intra venous fluid may be required to maintain the circulation
Parent education , Community based programs Thoroughly check your home to ensure that it's safe for children.
Install childproof locks on cabinets that house cleaning supplies. Never assume a cabinet is too high for a curious child.
Keep all household products in their original packaging, which includes first-aid information in the event of accidental exposure or ingestion of the product.
Read and follow the directions on the product label.
Don't leave cleaning buckets with liquid in them unattended. If a child falls into a bucket, it may not tip over, and the child could drown in even a small amount of liquid.
Schedule house cleaning during "down times," when children are having a nap or on a play date or at school.
Take out only the amount of cleaning product you need for the job you're doing at the moment. Keep the rest securely stored until you need it.
Immediately clean up any spillage.
Avoid distractions or interruptions when children are present while you're cleaning. If you need to answer the door, take the child with you. If the phone rings, let the answering machine get the call
Parent education , Community based programs
Thoroughly check your home to ensure that it's safe for children.
Install childproof locks on cabinets that house cleaning supplies. Never assume a cabinet is too high for a curious child.
Keep all household products in their original packaging, which includes first-aid information in the event of accidental exposure or ingestion of the product.
Read and follow the directions on the product label.
Don't leave cleaning buckets with liquid in them unattended. If a child falls into a bucket, it may not tip over, and the child could drown in even a small amount of liquid.
Schedule house cleaning during "down times," when children are having a nap or on a play date or at school.
Take out only the amount of cleaning product you need for the job you're doing at the moment. Keep the rest securely stored until you need it.
Immediately clean up any spillage.
Avoid distractions or interruptions when children are present while you're cleaning. If you need to answer the door, take the child with you. If the phone rings, let the answering machine get the call

Management - Specific

Fact Explanation
Inhalation Exposure Supplemental oxygen by mask to those who have
respiratory symptoms. Treat patients who have bronchospasm with
an aerosolized bronchodilator
Inhalation Exposure
Supplemental oxygen by mask to those who have
respiratory symptoms. Treat patients who have bronchospasm with
an aerosolized bronchodilator
Skin Exposure If concentrated hypochlorite solutions contact the skin, chemical
burns may occur; treat as thermal burns. Patients developing dermal
hypersensitivity reactions may require treatment with systemic or
topical corticosteroids or antihistamines.
Skin Exposure
If concentrated hypochlorite solutions contact the skin, chemical
burns may occur; treat as thermal burns. Patients developing dermal
hypersensitivity reactions may require treatment with systemic or
topical corticosteroids or antihistamines.
Eye Exposure Irrigate exposed or irritated eyes with saline, Ringer’s lactate, or
D5W for at least 20 minutes.Check the pH of the conjunctiva every
30 minutes for 2 hours after irrigation is stopped. If the pH is not
neutral an irrigating contact lens should be used to apply continuous
irrigation for several hours until the pH of the tissue normalizes. Test
visual acuity and examine the eyes for corneal damage and treat
appropriately. Immediately consult an ophthalmologist for patients
who have corneal injuries
Eye Exposure
Irrigate exposed or irritated eyes with saline, Ringer’s lactate, or
D5W for at least 20 minutes.Check the pH of the conjunctiva every
30 minutes for 2 hours after irrigation is stopped. If the pH is not
neutral an irrigating contact lens should be used to apply continuous
irrigation for several hours until the pH of the tissue normalizes. Test
visual acuity and examine the eyes for corneal damage and treat
appropriately. Immediately consult an ophthalmologist for patients
who have corneal injuries
Ingestion In cases of ingestion, do not induce emesis or offer activated
charcoal.
Give 4 to 8 ounces of water or milk to alert patients who can
swallow if not done previously. Dilutants are contraindicated in the
presence of shock, upper airway obstruction, or in the presence of
perforation.
Ingestion
In cases of ingestion, do not induce emesis or offer activated
charcoal.
Give 4 to 8 ounces of water or milk to alert patients who can
swallow if not done previously. Dilutants are contraindicated in the
presence of shock, upper airway obstruction, or in the presence of
perforation.

Concise, fact-based medical articles to refresh your knowledge

Access a wealth of content and skim through a smartly presented catalog of diseases and conditions.

  1. ADEDEJI TO, TOBIH JE, OLAOSUN AO, SOGEBI OA. Corrosive oesophageal injuries: a preventable menace Pan Afr Med J [online] :11 [viewed 13 August 2014] Available from: doi:10.11604/pamj.2013.15.11.2495
  2. JANG HS, KIM JY, CHOI SH, YOON YH, MOON SW, HONG YS, LEE SW. Comparative analysis of acute toxic poisoning in 2003 and 2011: analysis of 3 academic hospitals. J Korean Med Sci [online] 2013 Oct, 28(10):1424-30 [viewed 02 October 2014] Available from: doi:10.3346/jkms.2013.28.10.1424
  3. MCKENZIE L. B., AHIR N., STOLZ U., NELSON N. G.. Household Cleaning Product-Related Injuries Treated in US Emergency Departments in 1990-2006. PEDIATRICS [online] December, 126(3):509-516 [viewed 13 August 2014] Available from: doi:10.1542/peds.2009-3392
  4. NIXON J. Community based programs to prevent poisoning in children 0-15 years. Injury Prevention [online] 2004 January, 10(1):43-46 [viewed 02 October 2014] Available from: doi:10.1136/ip.2003.003822
  5. PRESGRAVE ROSAURA DE FARIAS, CAMACHO LUIZ ANTôNIO BASTOS, VILLAS BOAS MARIA HELENA SIMõES. A profile of unintentional poisoning caused by household cleaning products, disinfectants and pesticides. Cad. Saúde Pública [online] 2008 December, 24(12):2901-2908 [viewed 13 August 2014] Available from: doi:10.1590/S0102-311X2008001200019
  6. RIORDAN M. Poisoning in children 4: Household products, plants, and mushrooms. [online] 2002 November, 87(5):403-406 [viewed 13 August 2014] Available from: doi:10.1136/adc.87.5.403