Treatment for Harpic (Bleach) Ingestion
For Harpic (bleach) ingestion, immediately irrigate the affected area with copious amounts of water and do not administer anything by mouth unless advised by a poison control center or emergency medical personnel. 1
Immediate Management
- Contact a poison control center or emergency medical services immediately for guidance 1
- Do NOT administer activated charcoal as it is contraindicated for caustic substance ingestions and may cause additional harm 2, 1
- Do NOT induce vomiting as this can increase the risk of pulmonary complications from aspiration 3
- For household bleach specifically, dilution with water may be appropriate as the primary intervention 1
- Ensure the treatment area is well-ventilated to prevent inhalation of toxic fumes 1
Clinical Assessment
- Monitor for signs of respiratory compromise, including stridor, which may indicate chemical pneumonitis or airway injury 3
- Watch for symptoms such as hypersalivation and dysphagia, which are indicators of significant esophageal injury requiring endoscopic evaluation 4
- Be vigilant for signs of perforation, which would necessitate emergency surgical intervention 3
Hospital Management
- Protect the airway early if there are signs of respiratory involvement or deterioration 3
- Avoid blind insertion of nasogastric tubes due to risk of perforation and induction of regurgitation 3
- Administer intravenous fluids to correct metabolic imbalances 5
- Consider antibiotics if there is evidence of significant tissue damage 5
- Provide appropriate pain management with opiates as needed 5
Diagnostic Evaluation
- Esophagogastroduodenoscopy (EGD) may be performed to assess the extent of injury, particularly in patients with hypersalivation and dysphagia 6, 4
- Computed tomography may help define the extent of injury 6
Special Considerations
- Cold fluid lavage may be considered only after gastric aspiration in cases treated immediately following acid ingestion 7
- Simple dilution with water or weak-base neutralization should be approached with caution as these can generate significant heat with concentrated acids 7
- Never mix bleach with other household cleaning products, especially those containing ammonia, as this can create toxic gases 1
Common Pitfalls to Avoid
- Administering syrup of ipecac, which is no longer recommended for any toxin ingestion 2, 1
- Delaying airway protection in patients showing signs of respiratory involvement 3
- Focusing solely on digestive tract injury while overlooking potential respiratory tract damage from aspiration or fume inhalation 3