What is the emergency treatment for a 15-year-old male who ingested laundry detergent?

Emergency Treatment of Laundry Detergent Ingestion in a 15-Year-Old Male

Do not induce vomiting, do not give activated charcoal, and do not administer anything by mouth unless specifically directed by poison control—immediately contact the Poison Control Center (1-800-222-1222) while preparing for potential airway compromise and corrosive injury management. 1, 2

Immediate Actions in the Emergency Department

First Priority: Airway Assessment and Protection

• Assess for signs of airway compromise immediately, including stridor, drooling, difficulty swallowing, or respiratory distress, as laundry detergents (particularly concentrated pods/packets) can cause severe oropharyngeal and laryngeal edema 3
• Prepare for early endotracheal intubation if there are signs of upper airway edema, respiratory distress, or inability to protect the airway 1, 3
• Consider tracheostomy preparation if severe upper airway burns or edema are present, as this may be life-saving 3

Contraindicated Interventions

• Do NOT induce vomiting or administer ipecac—this is absolutely contraindicated and provides no benefit while potentially causing aspiration and further injury 1, 2, 4
• Do NOT perform gastric lavage—this is contraindicated in corrosive ingestions as it can cause perforation and worsen esophageal injury 3, 4
• Do NOT give activated charcoal—it is not effective for detergent ingestions and may cause aspiration or obstruct visualization during endoscopy 1, 2
• Do NOT give water or milk for dilution—no human studies demonstrate clinical benefit, and administration may cause emesis and aspiration 1, 2

Clinical Assessment and Monitoring

Evaluate for Corrosive Injury

• Examine the oropharynx for burns, erythema, or ulceration, though absence of oral lesions does not exclude esophageal or gastric injury 3
• Assess for symptoms of corrosive esophagitis: chest pain, dysphagia, odynophagia, drooling, or abdominal pain 3
• Monitor for systemic toxicity: altered mental status, seizures, metabolic acidosis, or hemolysis (particularly with cationic detergents) 2, 4

Diagnostic Approach

• Obtain contrast-enhanced CT of the chest and abdomen 3-6 hours after ingestion as the preferred initial diagnostic tool—this is more accurate than endoscopy for detecting transmural injuries and predicting stricture risk 3
• Consider upper endoscopy within 12-48 hours to assess injury severity and guide prognosis, but only after CT evaluation and with experienced practitioners 3
• Avoid endoscopy between 1-3 weeks post-ingestion due to significantly higher perforation risk during the healing phase 3

Supportive Care Measures

Immediate Stabilization

• Activate EMS protocols and implement standard resuscitation if the patient exhibits life-threatening signs: altered mental status, seizures, respiratory difficulty, or hemodynamic instability 1, 4
• Establish IV access and provide fluid resuscitation if hypotension is present 4
• Administer diazepam 0.1-0.3 mg/kg IV (maximum 10 mg) if seizures occur 1, 4
• Give atropine for severe bradycardia if present 1, 4

Respiratory Support

• Provide supplemental oxygen and monitor oxygen saturation continuously 4, 5
• Prepare for mechanical ventilation if respiratory depression or aspiration pneumonitis develops 5
• Obtain chest radiograph to evaluate for aspiration pneumonitis or chemical pneumonitis 5

Poison Control Center Consultation

Contact the Poison Control Center (1-800-222-1222) immediately to receive specific guidance on:

• The exact product ingested (bring the container if available) 1, 2
• Expected toxicity based on the specific detergent formulation 2
• Need for specialized monitoring or interventions 1, 6
• Duration of observation required 6

Disposition and Follow-Up

Hospital Admission Criteria

• Admit for observation any patient with:
  • Symptomatic ingestion (oral burns, dysphagia, respiratory symptoms, altered mental status) 3, 4
  • Intentional ingestion requiring psychiatric evaluation 3, 4
  • Evidence of corrosive injury on imaging 3
  • Significant volume ingested or concentrated product exposure 6

Surgical Consultation

• Obtain immediate surgical consultation if CT shows transmural necrosis, perforation, mediastinitis, or peritonitis 3
• Monitor for delayed complications including stricture formation (typically within 4 months) requiring endoscopic dilation 3

Critical Pitfalls to Avoid

• Do not rely solely on clinical symptoms to assess severity—patients may have significant esophageal injury without oral burns 3
• Do not delay imaging in symptomatic patients—early CT guides management and surgical decision-making 3
• Do not forget psychiatric evaluation for intentional ingestions, even when medical condition stabilizes 3, 4
• Do not discharge asymptomatic patients immediately—observe for at least several hours as symptoms may be delayed 4, 6