From the Guidelines
Accidental sodium hypochlorite (bleach) ingestion is a medical emergency that requires immediate attention, and the primary goal is to assess the severity of the injury and prevent further damage.
Emergency Management
- The first step in managing accidental sodium hypochlorite ingestion is to contact Poison Control Centers to evaluate systemic toxicity of the ingested agent 1.
- Initial laboratory evaluation should include CBC, serum concentrations of sodium, potassium, chlorine, magnesium, calcium, urea creatinine, liver tests, pH and serum lactate, blood alcohol levels, and measurement of β-HCG in young women 1.
- Computed tomographic evaluation is recommended to assess the extent of the injury, and a four-stage CT classification of esophageal caustic injuries can be used to guide management 1.
- Endoscopy is not the primary diagnostic tool in the emergency setting, but it may be used to evaluate the extent of the injury if CT is unavailable or contraindicated 1.
Indications for Surgical Treatment
- Surgery is indicated if the initial evaluation suggests transmural necrosis of the gastrointestinal tract (Grade III CT injuries) 1.
- All obvious transmural necrotic injuries should be resected during the initial operation, and a feeding jejunostomy is indicated at the end of the operation 1.
- Laparotomy remains the standard approach in the emergency setting, although successful laparoscopic management has been reported 1.
Key Considerations
- The quantity of the ingested agent and the accidental-voluntary ingestion pattern condition outcomes, and patients who do not have full-thickness necrosis of digestive organs can be offered non-operative management (NOM) under close clinical and biological monitoring 1.
- Emergency resection of caustic necrosis can be lifesaving, and the decision to perform an emergency operation after corrosive ingestion is a life-changing event for the patient 1.
From the Research
Emergency Management of Accidental Sodium Hypochlorite Ingestion
- The management of accidental sodium hypochlorite (bleach) ingestion is primarily focused on symptom-directed supportive care, as there is no specific antidote 2.
- In cases of small accidental ingestions, the clinical course is usually benign and does not require hospitalization, corticosteroids, or antibiotics unless there is severe dysphagia or signs of significant injury 3.
- For large ingestions, corrosive gastrointestinal injury and systemic effects, including metabolic acidosis, hypernatremia, and hyperchloremia, may occur 2.
- Fiberoptic endoscopy and CT thorax/abdomen are useful 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 2.
Clinical Features and Diagnosis
- The diagnosis of sodium hypochlorite poisoning 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 2.
- Clinical signs, such as hypersalivation, difficulty swallowing, retrosternal pain, or hematemesis, can suggest corrosive injury 2.
- Laboratory studies may reveal hypernatremia, hyperchloremia, and metabolic acidosis 4.
Treatment and Management
- Symptom-directed supportive care is the mainstay of management, with a focus on treating local corrosive injury in severe cases 2.
- Gastrointestinal decontamination is not beneficial, and treatment primarily consists of supportive care, with no specific antidote available 2.
- In cases of severe ingestion, hospitalization and intensive care may be necessary, with potential interventions including esophageal repair and colonic transplant 5.