sodium-hypochlorite and Poisoning

Sodium hypochlorite is used as a bleaching and disinfecting agent and is commonly found in household bleach.. The objective is to review critically the epidemiology, mechanisms of toxicity, clinical features, diagnosis, and management of hypochlorite poisoning.. PubMed was searched from January 1950 to June 2018 using the terms "Hypochlorite", "Sodium Hypochlorite", "Sodium Oxychloride", "Hypochlorous Acid", "Bleach", "Chlorine Bleach", in combination with the keywords "poisoning", "poison", "toxicity", "ingestion", "adverse effects", "overdose", and "intoxication". In addition, bibliographies of identified articles were screened for additional relevant studies including non-indexed reports. Non-peer-reviewed sources were also included. These searches produced 110 citations which were considered relevant.. There is limited information regarding statistical trends on world-wide poisoning from sodium hypochlorite. In the United States of America, poison control center data have shown that enquiries regarding hypochlorite bleaches have ranged from 43,000 to 46,000 per year over the period 2012-2016. Mechanisms of toxicity: Hypochlorite's potential to cause toxicity is related to its oxidizing capacity and the pH of the solution. Toxicity arises from its corrosive activity upon contact with mucous membranes and skin. Features following ingestion: While small accidental ingestions are very unlikely to cause clinically significant toxicity, large ingestions may cause corrosive gastrointestinal injury and systemic effects, including metabolic acidosis, hypernatremia, and hyperchloremia. Features following dental exposure: Hypochlorite is used extensively by dentists for cleaning root canals and is safe if the solution remains within the root canal. Extrusions into the periapical area can result in severe pain with localized large and diffuse swelling and hemorrhage. Features following skin exposure: Prolonged or extensive exposure may cause skin irritation and damage to the skin or dermal hypersensitivity. Such exposures can result in either immediate or delayed-type skin reactions. High concentration solutions have caused severe chemical skin burns. Features following inhalation: Although there are only limited data, inhalation of hypochlorite alone is likely to lead to no more than mild irritation of the upper airways. Features following ocular exposure: Corneal injuries from ocular exposure are generally mild with burning discomfort and superficial disturbance of the corneal epithelium with recovery within 1 or 2 days. With higher concentration solutions, severe eye irritation can occur.. The diagnosis can typically be made on the basis of a careful history, including details of the specific product used, its hypochlorite concentration, and the amount involved. As hypochlorite bleach produces a characteristic smell of chlorine, this may provide a diagnostic clue. In severe cases, corrosive injury is suggested on presentation because of hypersalivation, difficulty swallowing, retrosternal pain or hematemesis.. Symptom-directed supportive care is the mainstay of management. Gastrointestinal decontamination is not beneficial. Local corrosive injury is the major focus of treatment in severe cases. Fiberoptic endoscopy and CT thorax/abdomen are complimentary and have been shown to be useful in corrosive injuries in assessing the severity of injury, risk of mortality and risk of subsequent stricture formation and should be performed as soon as possible after ingestion. Dental periapical extrusion injuries should be left open for some minutes to allow bleeding through the tooth and to limit hematoma development in tissue spaces. Once the bleeding has ceased, the canal can be dressed with non-setting calcium hydroxide and sealed coronally.. Accidental ingestion of household bleach is not normally of clinical significance. However, those who ingest a large amount of a dilute formulation or a high concentration preparation can develop severe, and rarely fatal, corrosive injury so prompt supportive care is essential as there is no specific antidote. Treatment primarily consists of symptom-directed supportive care.

Topics: Acidosis; Animals; Disinfectants; Eye Diseases; Humans; Hypernatremia; Inhalation Exposure; Oxidants; Poisoning; Prognosis; Respiratory Tract Diseases; Risk Assessment; Skin Diseases; Sodium Hypochlorite; Tooth Bleaching Agents

Topics: Adult; Anti-Infective Agents, Local; Child; Child Welfare; Child, Preschool; Detergents; Diagnosis, Differential; Disinfectants; Embolism; Fluid Therapy; Humans; Hydrogen Peroxide; Infant; Pneumonia, Aspiration; Poisoning; Prognosis; Sodium Hypochlorite; Stomach

Accidental bleach ingestion is frequent in children but there is no agreement on its management. The results of a survey among 11 French poison centres about their recommendations in this intoxication are reported. Most of the centres adapt their guidelines according to the quantity and the concentration of the ingested bleach. In case of diluted bleach, no centre recommends an hospitalization when the quantity is smaller than 100 ml, whereas four of the 11 centres recommend it when the quantity is greater than 100 ml. In case of concentrate bleach ingestion nine of the 11 centres recommend an hospitalization whatever the amount, eight of them performing an emergency upper gastro intestinal (GI) endoscopy if clinical signs are present. In case of large ingestion of concentrate bleach ten centres recommend the hospitalization, eight perform an upper GI endoscopy between 6 and 8 hours post ingestion according to clinical signs, and two perform a systematic emergency upper GI endoscopy. Tablets and new bleach are considered as concentrate bleach. From these informations and a review of the literature, the authors emphasize the importance of the clinical signs as criteria for prediction of GI lesions regardless of the quantity or the concentration of ingested bleach.

Topics: Endoscopy, Digestive System; France; Hospitalization; Humans; Poison Control Centers; Poisoning; Prospective Studies; Sodium Hypochlorite

Topics: Accidents, Home; Ammonia; Carbon Tetrachloride Poisoning; Cooking and Eating Utensils; Cosmetics; Dermatitis, Atopic; Detergents; Enzymes; Ethylenes; Fatty Acids; Gastric Lavage; Humans; Hydrocarbons; Kidney Diseases; Lead Poisoning; Methanol; Phenols; Phosphates; Poisoning; Quaternary Ammonium Compounds; Soaps; Sodium Hydroxide; Sodium Hypochlorite; Solvents; Sulfates

Several studies worldwide have investigated household product poisoning. We conducted a toxico-clinical study on the two-year prevalence of poisoning with household products.. This cross-sectional study was performed in Khorshid Hospital, the main referral center for poisoning cases in Isfahan, affiliated to Isfahan University of Medical Sciences, Isfahan, central Iran. All patients with intentional or unintentional household substance poisoning, referring to the poisoning emergency center of the hospital, were evaluated with respect to epidemiological and toxico-clinical features and outcomes.. During the study period, 5946 patients were hospitalized, of which 83 (1.39%) had been poisoned with household products including 48 (57.8%) men and 35 (42.2%) women with a mean ± SD age of 34.40 ± 17.71 years. Most patients (54.2%) were in the 20-40-year-old age group. Accidental poisoning (63.9%) was the most common type of exposure (P = 0.02) predominantly in men (57.8%, P = 0.51). The most common household products were sodium hypochlorite (32.53%) followed by petroleum hydrocarbon (21.68%). Most of the accidental poisonings (77.8%) were due to petroleum hydrocarbon. 59% of cases were poisoned at home (P < 0.0001). No patient died.. Household products were not common means of poisoning in our referral center. Sodium hypochlorite and petroleum hydrocarbon were the most common substances. Most of the patients were men with accidental exposure at home. Because of the availability of the household product, the frequency and outcomes may be varied in different societies.

Topics: Adolescent; Adult; Cross-Sectional Studies; Female; Household Products; Humans; Male; Middle Aged; Petroleum; Poisoning; Poisons; Retrospective Studies; Sodium Hypochlorite; Young Adult

Most people are frequently exposed to chemicals and chemical products. This study provides basic information on the outcomes of acute chemical ingestion of patients aged under 19 years.. Patients aged under 19 years who had ingested chemicals and thus visited the emergency department between January 2011 and December 2016 were included in this study.. In all, 1,247 patients included (1,145 in the unintentional group and 102 in the intentional group). The mean age was 3.27±4.77 in the unintentional ingestion group and 16.49±1.94 in the intentional group. In the unintentional group, detergents were most frequently ingested (by 219 patients), followed by hypochlorite-based agents, ethanol, sodium hydroxide, acetone, silica gel, and citric acid. Cases of boric acid (odds ratio [OR] = 6.131), ethylene glycol (OR = 6.541), glacial acetic acid (OR = 7.644), other hydrocarbons (OR = 4.496), hypochlorite-based agent (OR = 2.627), nicotine (OR = 5.635), and sodium peroxocarbonate (OR = 6.783) ingestion was associated with a significantly high admission rate. In the intentional group, there were 54 cases of ingestion of hypochlorite-based agent, followed by detergent, ethylene glycol, ethanol, methanol and sodium peroxycarbonate. The significant risk factors for admission in the intentional group were ingestion of ethylene glycol (OR = 37.333) and hypochlorite-based agent (OR = 5.026). There was no mortality case.. The most commonly ingested substances were sodium hypochlorite (hypochlorite-related agent), surfactants (detergent and soap), and ethanol. The ingestion of hypochlorite or ethylene glycol was the main risk factor for admission. Intentional ingestion was higher in adolescents than in children.

Topics: Adolescent; Child; Child, Preschool; Eating; Emergency Medical Services; Emergency Service, Hospital; Ethanol; Female; Humans; Infant; Inorganic Chemicals; Male; Organic Chemicals; Poisoning; Republic of Korea; Retrospective Studies; Sodium Hypochlorite; Surface-Active Agents

Humans accumulate large numbers of inorganic particles in their lungs over a lifetime. Whether this causes or contributes to debilitating disease over a normal lifespan depends on the type and concentration of the particles. We developed and tested a protocol for in situ characterization of the types and distribution of inorganic particles in biopsied lung tissue from three human groups using field emission scanning electron microscopy (FE-SEM) combined with energy dispersive spectroscopy (EDS). Many distinct particle types were recognized among the 13 000 particles analyzed. Silica, feldspars, clays, titanium dioxides, iron oxides and phosphates were the most common constituents in all samples. Particles were classified into three general groups: endogenous, which form naturally in the body; exogenic particles, natural earth materials; and anthropogenic particles, attributed to industrial sources. These in situ results were compared with those using conventional sodium hypochlorite tissue digestion and particle filtration. With the exception of clays and phosphates, the relative abundances of most common particle types were similar in both approaches. Nonetheless, the digestion/filtration method was determined to alter the texture and relative abundances of some particle types. SEM/EDS analysis of digestion filters could be automated in contrast to the more time intensive in situ analyses.

Topics: Adult; Biopsy; Environmental Illness; Humans; Indicators and Reagents; Inhalation Exposure; Inorganic Chemicals; Lung; Metals; Microscopy, Electron, Scanning; Military Medicine; Military Personnel; Particle Size; Particulate Matter; Poisoning; Sodium Hypochlorite; Soil; Spectrometry, X-Ray Emission; United States

A 19-year-old man who developed extensive oesophageal lye (Alkali) stricture and received long-term enteral nutrition (eight months) with a jejunostomy tube developed macrocytic anaemia (Hb: 41 g/L) with leucopenia (white blood cell [WBC]: 3.0 x 10(9)/L). The patient's serum vitamin B12, folate, iron and liver function tests were normal. Bone marrow examination revealed gross erythroid hyperplasia and cytoplasmic vacuolization of erythroid and myeloid elements. Further investigations revealed low serum copper (0.3 micromol/L) and ceruloplasmin concentrations (<30 mg/L) with marginally low normal serum concentration of red cell peroxidase (13 U/gHb), establishing the diagnosis of copper deficiency anaemia. The anaemia and leucopenia responded intermittently to intravenous copper therapy, but the serum copper concentration dropped when intravenous copper therapy was withdrawn. Enteral jejunostomy copper supplementation failed to maintain adequate serum copper concentrations. After stabilizing the general condition of the patient, a pharyngo-gastric anastamosis was performed and normal oral diet commenced, which restored normal serum copper concentration. This case report suggests that copper supplements in the form of copper sulphate are not adequately absorbed when administered through a jejunostomy tube.

Topics: Adult; Anemia, Macrocytic; Ceruloplasmin; Copper; Deficiency Diseases; Enteral Nutrition; Gastroenterostomy; Humans; Injections, Intravenous; Jejunostomy; Leukopenia; Male; Poisoning; Sodium Hypochlorite

Dettol (4.8% chloroxylenol, 9% pine oil and 12% isopropyl alcohol) has previously been reported to cause delayed upper airway obstruction when ingested, despite the product being labelled as non-poisonous. Domestos (1-5% sodium hypochlorite) is used as a household and toilet cleaner. This paper reports a rare case in which both agents were consumed together in significant quantities, and caused stridor and impending airway obstruction requiring endotracheal intubation in the emergency department. Patients who have ingested this combination of cleaning agents are at high risk of acute airway compromise, and should have expert upper airway evaluation and control as soon as possible after admission.

Topics: Administration, Oral; Aged; Airway Obstruction; Emergency Medical Services; Female; Humans; Poisoning; Respiratory Sounds; Sodium Hypochlorite; Treatment Outcome; Xylenes

To assess accidental poisoning in children in the Caribbean country of Antigua and Barbuda, including the incidence, the types of substances ingested, the age of the children involved, and the clinical outcomes. The results from Antigua and Barbuda were compared with the results of other reports from the English-speaking Caribbean and from the United States of America.. We performed a retrospective review of the charts of all patients less than 13 years old admitted to the Children's Ward at Holberton Hospital in Antigua for accidental poisoning between March 1989 and March 1999. Those data were compared with data from earlier reports from Barbados, Guyana, Jamaica, and the United States of America.. In Antigua and Barbuda there were 255 hospital admissions for accidental poisoning among children below 13 years old over that 10-year period. Of the 255 ingestions, 115 of them (45%) were in 1-year-old children, 69 (27%) were in 2-year-old children, and 26 (10%) were in 3-year-old children. These proportions in Antigua and Barbuda are similar to the age patterns seen in the other countries with which we made comparisons. In Antigua and Barbuda there was an annual average of 26 hospital admissions for poisoning for the roughly 20,000 children below 13 years of age, for a rate of 1.3 per 1,000. In comparing the patterns of childhood poisoning in all the countries we studied, we found that, as economic levels rose, there was a shift in the substances ingested, with hydrocarbon and plant ingestions decreasing and chemical and medication ingestions increasing.. There is an increasing variety and complexity of poisonous substances ingested as economic conditions improve. This trend would make the establishment of a poison control center for the English-speaking Caribbean a logical step.

Topics: Antigua and Barbuda; Caribbean Region; Child; Child, Preschool; Drug-Related Side Effects and Adverse Reactions; Humans; Hydrocarbons; Infant; Kerosene; Plant Poisoning; Poisoning; Poisons; Retrospective Studies; Socioeconomic Factors; Sodium Hypochlorite

Caustic products are responsible for the most serious cases of poisoning, which are always emergency cases. Application of current intervention procedures has decreased both morbidity and mortality. Water-diluted bleach, the ingestion of which remains extremely frequent, is a moderate irritant rather than a caustic product. Emission of gas produced when mixing bleach with other agents can be responsible for choking gas poisoning. Anionic and nonionic detergents are mostly dangerous because of their foam-producing properties. Mercury vapours and methanol are other potentially hazardous products.

Topics: Acute Disease; Adult; Aged; Burns, Chemical; Caustics; Child; Detergents; Esophageal Stenosis; Household Products; Humans; Middle Aged; Poisoning; Sodium Hypochlorite; Stomach

Topics: Ammonia; Cause of Death; Female; Forensic Medicine; Hospitals; Humans; Poisoning; Sodium Hypochlorite; Sulfuric Acid Esters; Toxicology

NaClO effect on rat central neuron morphology and transcription after injection of high doses (500 mg/kg b.w.) of nembutal (NB) was studied. Cortical pyramids, Purkinje, basket and granule cells were examined. NaClO (3 mg/kg b.w) was injected 45 min after NB injection, and 45 min later animals were sacrificed. Intact rats and rats injected NB or NaClO alone were controls. NB treatment resulted in toxic-hypoxic injury of cerebral and cerebellar neurons. Transcription in all types of neurons was lower than in control cells. NaClO injected alone had virtually no effect on neuronal morphology while transcription in the middle pyramids and Purkinje cells was activated. NaClO injected after NB normalized morphology and transcription in all neuronal populations under study. In cortical pyramids transcription was even higher than in control group.

Topics: Acute Disease; Animals; Brain; Drug Evaluation, Preclinical; Male; Neurons; Pentobarbital; Poisoning; Rats; Sodium Hypochlorite; Time Factors; Transcription, Genetic

A housewife cleaned toilet porcelain connected directly to a sewage storage tank with a mixture of cleaning agents; sodium hypochlorite (NaOCl) and hydrochloric acid (HCl) solutions. She complained of insomnia on the night after cleaning and suffered from severe metabolic acidosis with extremely low blood pH, PCO2 and bicarbonate values. She recovered from the acidosis after bicarbonate transfusion, plasmapheresis and plasma exchange. Permanent blindness ensued, however, from the third day after the event. These clinical symptoms suggested that the toxic substances responsible were chloramine and methyl chloride. Their generation was confirmed by in-vitro experiments, mixing NaOCl, HCl and pooled urine from normal people. In the simulation, the methyl chloride level far exceeded (100,000 ppm) the maximal allowable concentration recommended (ca 400 ppm) by the American Conference of Governmental Industrial Hygienists (ACGIH). Chloramine's toxic actions were confirmed using purified enzyme assay, and the inhibition of carbonic anhydrase and aldehyde dehydrogenase and the enhancement of superoxide dismutase activity were confirmed in neutral pH. The patient's clinical symptoms suggested that insomnia and permanent blindness seemed to be partly ascribable to chronic repetitive exposure to methyl chloride; catching a cold, drug intake and alcohol intake, in addition, precipitated the patient's visual loss. The possibility of this kind of intoxication with such a mixture of agents may lie latent in any situation where sewage or garbage are exposed to the open air.

Topics: Acidosis; Adult; Aldehyde Dehydrogenase; Anorexia; Blindness; Carbonic Anhydrases; Chloramines; Chlorine; Detergents; Drug Interactions; Environmental Exposure; Female; Humans; Hydrochloric Acid; Methyl Chloride; Poisoning; Sleep Initiation and Maintenance Disorders; Sodium Hypochlorite; Superoxide Dismutase; Toilet Facilities

A case of fatal poisoning in a 1-year-old girl after ingestion of a household cleanser containing 4.5% sodium hypochlorite (Klorin) in an alkaline solution (pH 12.0) is reported. The forensic medical and toxicological investigations were supplemented by animal studies. These studies indicate that 5, 10, and 15 ml of Klorin/kg body wt given to rats is highly toxic, and that local tissue damage and secondary systemic involvement develops with a severity corresponding to the amount administered. The rats, all of which died, showed various degrees of degeneration and necrosis of the esophagoventricular mucosus membranes, changes analogous to those found at the autopsy of the child. A follow-up investigation of similar cases reported to the Swedish Poison Information Centre, during a limited time, was made to complete the picture.

Topics: Accidents; Adolescent; Adult; Aged; Animals; Child; Child, Preschool; Esophagus; Female; Gastrointestinal Contents; Humans; Infant; Liver; Lung; Necrosis; Poisoning; Portal Vein; Rats; Sodium Hypochlorite; Stomach

Topics: Acetates; Animals; Benzalkonium Compounds; Disinfectants; Foodborne Diseases; Formaldehyde; Iodine; Lactones; Mice; Poisoning; Shellfish; Sodium Hypochlorite; Toxins, Biological