What are the treatment options for clorhexidine (chlorhexidine) oral ingestion?

Treatment for Chlorhexidine Oral Ingestion

In case of chlorhexidine oral ingestion, immediate medical help or contact with a Poison Control Center is essential as it can lead to serious adverse effects including respiratory distress syndrome in severe cases. 1

Initial Management

1. Immediate interventions:

   • Remove any remaining chlorhexidine from the mouth
   • Contact Poison Control Center immediately
   • Seek emergency medical attention, especially if large amounts were ingested

2. First aid measures based on chemical properties:

   • Chlorhexidine is a cation, so anionic materials can be used as first-line treatment 2
   • Consider administration of:
     • Toothpaste (contains anionic detergents) to rinse the oral cavity
     • Alginate syrup (5% w/v) if available
   • These measures may help bind the chlorhexidine and reduce absorption 2

Hospital Management

1. Respiratory support:

   • Monitor closely for signs of respiratory distress
   • Be prepared for rapid intubation if aspiration is suspected
   • Chlorhexidine aspiration can lead to acute respiratory distress syndrome (ARDS), which can be fatal 3

2. Gastrointestinal decontamination:

   • Gastric lavage with demulcents may be considered for significant ingestions
   • Activated charcoal administration if within 1 hour of ingestion and patient is alert

3. Supportive care:

   • IV fluid support if hypotension develops
   • Monitor vital signs and oxygen saturation
   • Assess for systemic absorption (though typically limited with oral ingestion unless aspiration occurs)

Monitoring for Complications

1. Watch for common adverse effects:

   • Taste changes (may last 8-48 hours) 2
   • Headache, euphoria, giddiness
   • Blurred vision (may last up to 12 hours)
   • Stomachache (may last up to 24 hours)
   • Sore mouth/throat and tongue irritation 4

2. Monitor for severe complications:

   • Respiratory distress - particularly important as aspiration of chlorhexidine can lead to ARDS 3
   • Allergic reactions - ranging from mild contact dermatitis to life-threatening anaphylaxis 5
   • Wheezing/shortness of breath 4

Special Considerations

• Elderly patients and those with dementia are at higher risk for aspiration and subsequent complications 3
• Patients with history of allergic reactions to chlorhexidine require more vigilant monitoring 5
• The risk of severe outcomes increases with larger volumes of ingestion, particularly with concentrated solutions (e.g., 5% vs. the standard 0.2% mouthwash) 2

Prognosis

• Most accidental ingestions of small amounts result in mild, self-limiting symptoms
• However, aspiration following ingestion can lead to severe respiratory distress and potentially death 3
• Complete recovery of taste sensation typically occurs within 48 hours 2

Prevention

• Store chlorhexidine products safely out of reach of children and confused adults
• Clearly label all chlorhexidine solutions, particularly concentrated ones used in healthcare settings
• Consider alternative antiseptic options for patients with cognitive impairment or those at high risk for accidental ingestion