Domex (Sodium Hypochlorite) Ingestion: Emergency Management
For household bleach ingestion, immediately dilute with water or milk if the patient can swallow safely, do NOT induce vomiting, do NOT use activated charcoal, and contact poison control or emergency services immediately for all but the smallest accidental sips. 1
Immediate Actions
First Response:
- Dilute immediately with water or milk if the patient is conscious and able to swallow safely 1, 2
- Do NOT induce vomiting with ipecac or any other method—this increases risk of re-exposure and aspiration 1
- Do NOT administer activated charcoal—it is contraindicated and may cause additional harm 1
- Contact poison control center or emergency medical services immediately for guidance 1
Critical Don'ts:
- Never perform gastric lavage—this was done in one fatal case and likely worsened outcomes 3
- Do not delay transport for home interventions beyond simple dilution 2
Clinical Assessment
Severity Stratification:
Small accidental ingestions (sips) are typically benign and cause only transient symptoms 2. However, large volume ingestions can be fatal and require immediate emergency department evaluation 4, 5.
Key Clinical Features to Assess:
- Oral/pharyngeal findings: Hypersalivation, oral mucosal discoloration or burns, difficulty swallowing 2, 5
- Gastrointestinal injury: Retrosternal pain, hematemesis, abdominal pain 2, 3
- Respiratory compromise: Stridor, dyspnea, airway edema (rare but life-threatening) 6
- Systemic toxicity: Altered mental status, slurred speech, shock 5
Hospital Management
Laboratory Evaluation for Significant Ingestions:
- Serum electrolytes: Look for hypernatremia (can reach 169 mEq/L), hyperchloremia (>143 mEq/L) 5
- Arterial blood gas: Assess for metabolic acidosis 5
- Complete blood count, renal function 2
Imaging Studies:
Perform fiberoptic endoscopy and CT chest/abdomen as soon as possible after significant ingestion to assess severity of corrosive injury, mortality risk, and stricture formation risk 2. These are complementary modalities.
- CT findings may reveal: Esophageal perforation, pneumomediastinum, pneumothorax, pneumoperitoneum, pleural effusion 5, 3
- Barium esophagography can identify contrast leakage indicating perforation 3
Supportive Care:
- Airway management: Intubation may be required for airway edema or altered mental status 5, 6
- Fluid resuscitation: Aggressive IV fluids for hypotension and electrolyte abnormalities 5
- Correct metabolic acidosis with sodium bicarbonate 5
- Chest tube placement for pneumothorax if present 5
- NPO status until extent of gastrointestinal injury is determined 3
Complications and Prognosis
Acute Complications:
- Esophageal or gastric perforation with mediastinitis 3
- Bilateral pneumothoraces 5
- Severe airway edema requiring prolonged intubation 6
- Cardiovascular collapse and cardiac arrest 5
Long-term Sequelae:
- Esophageal stricture formation requiring dilation or surgical reconstruction 3
- One case required delayed esophageal repair and colonic transplant 12 weeks post-ingestion 3
Mortality: While rare, fatal outcomes have been documented with large volume ingestions, particularly when complicated by perforation and systemic toxicity 4, 5.
Mechanism of Toxicity
Household bleach (typically 3-6% sodium hypochlorite, pH 11-13) causes injury through:
- Direct corrosive damage to mucous membranes from alkaline pH 2
- Oxidizing capacity causing cellular injury 2
- Systemic effects from absorption: hypernatremia, hyperchloremia, metabolic acidosis 5
Special Considerations
Concentration matters: Most household bleach is 3-6% sodium hypochlorite and relatively dilute 2. Higher concentration industrial products cause more severe injury 2.
Characteristic odor: The smell of chlorine may provide a diagnostic clue 2.
Psychiatric evaluation: Many serious ingestions are intentional suicide attempts requiring psychiatric assessment once medically stable 4, 3.