Emergency Medicine Book


Sodium Hypochlorite Poisoning

Aka: Sodium Hypochlorite Poisoning, Chlorine Bleach Ingestion, Bleach Toxicity, Sodium Hypochlorite Toxicity, Disinfectant Poisoning
  1. See Also
    1. Toxin Ingestion
    2. Caustic Ingestion
    3. Hydrogen Peroxide Poisoning
  2. Background
    1. Chlorine Bleach uses
      1. Whitening of clothing (bleaching)
      2. Cleaning and disinfection
        1. Bleach kills most microorganisms (e.g. viruses, Bacteria, fungi, algae)
    2. Chlorine Bleach components
      1. Bleach is a mixture of Sodium hydroxide (strong base), Hydrogen Peroxide (oxidizer) and calcium Hypochlorite
      2. Alkaline solution (pH 12.6) prevents Hypochlorite degradation to Chlorine gas
      3. Alternatives to Chlorine bleach: Non-Chlorine Bleach (peroxide based agents)
    3. Concentrations of sodium Hypochlorite (NaOCl)
      1. Household bleach is 3 to 6% (up to 8% for concentrated) sodium Hypochlorite (NaOCl)
      2. Industrial bleach is 12 to 15% (over 20% in some cases) sodium Hypochlorite (NaOCl)
        1. Used for water Decontamination, industrial cleaning (e.g. roofs)
  3. Mechanism: Exposures
    1. Aerosolized or Aspiration (lung or eye exposures)
    2. Contact (eye or skin exposures)
    3. Ingestion (gastrointestinal)
    4. Toxic gas exposure when bleach is mixed with other agents (esp. other cleansers)
      1. Chlorine gas exposure occurs when bleach is mixed with acid
      2. Chloramine gas exposure occurs when bleach is mixed with ammonia
  4. Findings
    1. Skin
      1. Local irritation in regions of contact (may cause minor, superficial burns)
      2. May contaminate mucous membranes (e.g. fingers touch eyes)
    2. Eyes
      1. See Chemical Eye Injury
      2. Chemical Conjunctivitis
      3. Corneal Injury
    3. Gastrointestinal
      1. Oral Mucosal burn, odynophagia, Drooling, Dysphagia or Sore Throat
      2. Esophagitis, ulceration, necrosis or Esophageal Perforation
      3. Gastritis, necrosis or gastric perforation
      4. Mediastinitis
    4. Respiratory
      1. Stridor
    5. Metabolic
      1. Hyperchloremic Metabolic Acidosis
      2. Hypernatremia
      3. Hyperchloremia
  5. Labs
    1. Serum Electrolytes
      1. Indicated in large ingestions
  6. Imaging
    1. Chest XRay
      1. Indicated in Inhalation Injury or Dyspnea
  7. Procedures
    1. Endoscopy
      1. Indicated in symptomatic ingestion with pain, Dysphagia, Hematemesis
      2. Indicated in large, typically intentional ingestion (>40 ml or >5 ml/kg)
  8. Management
    1. See Caustic Ingestion
    2. Decontamination
      1. Avoid Activated Charcoal (contraindicated)
      2. Nasogastric suction may be considered in massive, recent ingestions
      3. Irrigate eyes if exposed
      4. May rinse mouth, skin if irritated
      5. Remove contaminated clothing
    3. Children
      1. Most ingestions are small and require evaluation only if symptomatic
      2. Esophageal burns may occur
    4. Adults
      1. Observe for 4-6 hours after ingestion
      2. Manage airway as needed
      3. Consider early endoscopy for larger or symptomatic ingestions
      4. May discharge home when asymptomatic and able to eat and drink
  9. References
    1. Tomaszewski (2020) Crit Dec Emerg Med, COVID-19 Special Edition
    2. Tomaszewski (2020) Crit Dec Emerg Med 34(2): 28
    3. Benzoni and Hatcher (2020) Bleach Toxicity, StatPearls, accessed 8/28/2020
      1. https://www.ncbi.nlm.nih.gov/books/NBK441921/

Bleach causing toxic effect (C0413152)

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)
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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