Laundry detergent pod ingestion

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

• No effects - 24%
• Vomiting - 66%
• Respiratory complaints (cough, stridor, SOB) - 16%
• Altered mental status - 9%
• Eye irritation - 8%
• Skin irritation - 0.5%
• 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
  • Anticholinergic toxicity
  • Antihistamines
  • TCA toxicity
• Malignant Hyperthermia
  • anesthetics
• Neuroleptic Malignant Syndrome
  • Phenothiazines, Lithium, LevoDopa

Hypothermia

• Exposure
  • Ethanol Toxicity
  • Sedative/Hypnotics
  • Opioids
  • TCAs
  • Phenothiazines
  • Insulin (Hypoglycemia)

Increased Respiratory Rate

• Direct Stimulation
  • Aspirin (Salicylate) Toxicity
  • Metabolic acidosis
  • dintirophenol, pentachlorophenol
  • Hepatorenal syndrome
  • CNS stimulants (cocaine, amphet, theophylline)
• Tissue Hypoxia
  • CO
  • Cyanide
  • Hydrogen Sulfide
  • Methemoglobinemia

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

• Chem 7
• 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
• Ondansetron 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

• Toxicology (main)

External Links

• The Poison Review - Laundry ‘pods’: more toxic than your mom’s detergent