History

Fact Explanation
Cough, breathing difficulty [1] 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 [1]
Vomiting/ vomiting blood, abdominal pain, blood in stools [2] 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 [1]
Loss of vision [1] Direct contact with hypochlorite solutions, powder, or concentrated vapor causes severe chemical burns, leading to cell death and ulceration [2]
Skin burns [3] Hypochlorite irritates the skin and can cause burning pain, inflammation, and blisters [3]
Seizures [3] Severe change in the acid level in the blood (pH balance), can lead to seizures.Electrolyte imbalances can also cause seizures [1]
Unconscious [3] Acid base disturbances and electrolyte imbalances can lead to shock [3]
Poor education level of parents [4] Risk factor due to improper guidance and care of the children [3]
References
  1. 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
  2. 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
  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. 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

Examination

Fact Explanation
Dyspnea [1] Due to inhalation injury.Hypochlorite solutions can liberate toxic gases such as chlorine which causes irritation of the respiratory tract [2]
Abdominal tenderness [1] Ingestion of cleaning substances cause irritation of the gastro intestinal tract [3]
Convulsions [1] Severe change in the acid level in the blood (pH balance), can lead to seizures.Electrolyte imbalances can also cause seizures [3]
Hypotension, tachycardia, cold peripheries [3] Acid base disturbances and electrolyte disturbances can cause shock [3]
References
  1. 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
  2. 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
  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

Differential Diagnoses

Fact Explanation
Gastroesophageal reflux in infants and children [1] Will present with abdominal pain, vomiting. Endoscopy may show ulcers. Other features of cleaning substance poisoning such as convulsions are absent.No history of accidental poisoning [1]
References
  1. JUNG AD. Gastroesophageal reflux in infants and children. Am Fam Physician [online] 2001 Dec 1, 64(11):1853-60 [viewed 13 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/11764863

Investigations - for Diagnosis

Fact Explanation
Upper gastro intestinal tract endoscopy [1] 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. [1]
Arterial blood gas analysis [2] Chlorine inhalation may be complicated by hyperchloremic metabolic acidosis [2]
References
  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. 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

Investigations - Fitness for Management

Fact Explanation
Serum electrolytes [1] Poisoning due to ion (eg:sodium, calcium etc) containing products can cause electrolyte imbalances [1]
References
  1. 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

Investigations - Followup

Fact Explanation
Upper gastro intestinal tract endoscopy [1] To look for chronic complications - esophageal obstruction, pyloric stenosis,squamous cell carcinoma of the esophagus [1]
References
  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

Investigations - Screening/Staging

Fact Explanation
Electrocardiogram [1] To identify electrolyte imbalances which can cause arrhythmia [1]
References
  1. 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

Management - General Measures

Fact Explanation
Emergency management [1] 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 [1]
Parent education [2], Community based programs [3] 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 [2]
References
  1. 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
  2. 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
  3. 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

Management - Specific Treatments

Fact Explanation
Inhalation Exposure [1] Supplemental oxygen by mask to those who have respiratory symptoms. Treat patients who have bronchospasm with an aerosolized bronchodilator [1]
Skin Exposure [1] 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. [1]
Eye Exposure [1] 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 [1]
Ingestion [1] 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. [1]
References
  1. 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