II. Background
-
Chlorine Bleach uses
- Whitening of clothing (bleaching)
- Cleaning and disinfection
- Bleach kills most Microorganisms (e.g. viruses, Bacteria, fungi, algae)
-
Chlorine Bleach components
- Bleach is a mixture of Sodium hydroxide (strong base), Hydrogen Peroxide (oxidizer) and calcium Hypochlorite
- Alkaline solution (pH 12.6) prevents Hypochlorite degradation to Chlorine gas
- Alternatives to Chlorine bleach: Non-Chlorine Bleach (peroxide based agents)
- Concentrations of sodium Hypochlorite (NaOCl)
- Household bleach is 3 to 6% (up to 8% for concentrated) sodium Hypochlorite (NaOCl)
- Industrial bleach is 12 to 15% (over 20% in some cases) sodium Hypochlorite (NaOCl)
- Used for water Decontamination, industrial cleaning (e.g. roofs)
III. Mechanism: Exposures
- Aerosolized or Aspiration (lung or eye exposures)
- Contact (eye or skin exposures)
- Ingestion (gastrointestinal)
- Toxic gas exposure when bleach is mixed with other agents (esp. other cleansers)
- Chlorine gas exposure occurs when bleach is mixed with acid
- Chloramine gas exposure occurs when bleach is mixed with ammonia
IV. Findings
- Skin
- Local irritation in regions of contact (may cause minor, superficial burns)
- May contaminate mucous membranes (e.g. fingers touch eyes)
- Eyes
- See Chemical Eye Injury
- Chemical Conjunctivitis
- Corneal Injury
- Gastrointestinal
- Oral Mucosal burn, odynophagia, Drooling, Dysphagia or Sore Throat
- Esophagitis, ulceration, necrosis or Esophageal Perforation
- Gastritis, necrosis or gastric perforation
- Mediastinitis
- Respiratory
- Metabolic
V. Labs
- Serum Electrolytes
- Indicated in large ingestions
VI. Imaging
-
Chest XRay
- Indicated in Inhalation Injury or Dyspnea
VII. Procedures
- Endoscopy
- Indicated in symptomatic ingestion with pain, Dysphagia, Hematemesis
- Indicated in large, typically intentional ingestion (>40 ml or >5 ml/kg)
VIII. Management
- See Caustic Ingestion
-
Decontamination
- Avoid Activated Charcoal (contraindicated)
- Nasogastric suction may be considered in massive, recent ingestions
- Irrigate eyes if exposed
- May rinse mouth, skin if irritated
- Remove contaminated clothing
- Children
- Most ingestions are small and require evaluation only if symptomatic
- Esophageal burns may occur
- Adults
- Observe for 4-6 hours after ingestion
- Manage airway as needed
- Consider early endoscopy for larger or symptomatic ingestions
- May discharge home when asymptomatic and able to eat and drink
IX. References
- Tomaszewski (2020) Crit Dec Emerg Med, COVID-19 Special Edition
- Tomaszewski (2020) Crit Dec Emerg Med 34(2): 28
- Benzoni and Hatcher (2020) Bleach Toxicity, StatPearls, accessed 8/28/2020
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Injury or Poisoning (T037) |
SnomedCT | 241847003 |
Spanish | efecto tóxico causado por blanqueador (trastorno), blanqueador que causa efectos tóxicos (trastorno), blanqueador que causa efectos tóxicos, efecto tóxico causado por blanqueador |
English | Bleach causing toxic effect, Bleach causing toxic effect (disorder) |
Ontology: Disinfectant poisoning (C0919682)
Concepts | Injury or Poisoning (T037) |
Italian | Avvelenamento da disinfettante |
Japanese | 消毒薬中毒, ショウドクヤクチュウドク |
English | poisoning by disinfectants (diagnosis), poisoning by disinfectants, Disinfectant poisoning |
Czech | Otrava dezinfekčním prostředkem |
Hungarian | Fertőtlenítőszer mérgezés |
Portuguese | Intoxicação por desinfectante |
Spanish | Intoxicación por desinfectante |
Dutch | ontsmettingsmiddelenvergiftiging |
French | Intoxication par désinfectant |
German | Vergiftung mit Desinfektionsmitteln |
Ontology: Sodium hypochlorite toxicity (C0920060)
Concepts | Injury or Poisoning (T037) |
Dutch | laag natriumchloridevergiftiging |
German | Natriumhypochlorid, Toxizitaet |
Italian | Tossicità da ipoclorito di sodio |
Portuguese | Toxicidade do hipoclorito de sódio |
Spanish | Toxicidad por hipoclorito de sodio |
Japanese | 次亜塩素酸ナトリウム毒性, ジアエンソサンナトリウムドクセイ |
French | Toxicité à l'hypochlorure de sodium |
Czech | Toxicita chlornanu sodného |
Hungarian | Nátrium-hipoklorid toxicitás |
English | Sodium hypochlorite toxicity |