What is the treatment for detergent ingestion?

Treatment for Detergent Ingestion

For detergent ingestion, do NOT perform gut decontamination; instead, provide supportive care with close monitoring for respiratory compromise, neurological depression, and airway injury, as these can develop rapidly and unpredictably, particularly with concentrated laundry pod exposures. 1

Immediate Management

Initial Assessment and Decontamination

• Rinse the mouth with small amounts of water or milk - this is the only recommended decontamination measure 1
• Do NOT induce vomiting - gut decontamination including activated charcoal, gastric lavage, or emesis is contraindicated 1
• Do NOT give large volumes of fluid - this may promote vomiting and increase aspiration risk 1

Critical Monitoring Parameters

Monitor closely for the following features, which can develop rapidly:

• Respiratory symptoms (occur in 56% of symptomatic patients): stridor, drooling, respiratory distress, coughing, laryngospasm, bronchospasm 2, 3
• Neurological depression (rare but serious): drowsiness, altered mental status, CNS depression requiring intubation 4, 1
• Gastrointestinal symptoms (most common): vomiting (occurs in 50-78% of symptomatic cases), throat pain, drooling 3, 1

Common pitfall: Laundry pod exposures cause unexpectedly severe toxicity compared to traditional liquid detergents, with rapid onset of neurological impairment and airway compromise 4. Do not underestimate these exposures based on the benign reputation of older detergent formulations.

Supportive Care Algorithm

For Mild Symptoms (Isolated Vomiting, No Respiratory/Neurological Features)

• Observe for 4-6 hours in emergency department or overnight observation unit 3
• Provide oral fluids as tolerated after initial mouth rinsing 1
• Discharge home if symptoms resolve and patient remains stable 3

For Moderate Symptoms (Respiratory Symptoms, Persistent Vomiting, Drooling)

• Admit to hospital for observation 3
• Administer supplemental oxygen for hypoxemia 1
• Provide bronchodilators for laryngospasm or bronchospasm 1
• Obtain chest radiograph if respiratory features develop 1
• Consider endoscopy if swallowing difficulties, persistent drooling, or oropharyngeal burns are present 1

For Severe Symptoms (Respiratory Depression, CNS Depression, Airway Compromise)

• Intubate immediately for inability to protect airway or respiratory depression 4, 1
• Provide assisted ventilation as needed 1
• Perform urgent endoscopy to assess for esophageal or gastric injury 1
• Consider MRI if substantial mucosal damage is found on endoscopy 1
• Correct acid-base disturbances (metabolic acidosis and hyperlactatemia can occur rarely) 1
• Administer intravenous fluids for prolonged vomiting or diarrhea 1

Critical consideration: Three of four children in one case series required intubation, with hospital courses lasting at least one week 4. Maintain a low threshold for endoscopic evaluation and ICU admission with severe symptoms 3.

Specific Toxicity Mechanisms

The primary toxic mechanism involves non-ionic surfactants (10-20% concentration in pods), though anionic surfactants (20-35%), ethanol (2-5%), and propylene glycol (8-20%) also contribute 1. These agents cause:

• Denaturation of proteins in mucous membranes 5
• Systemic absorption with distribution to lungs, liver, kidneys, and brain 5
• Direct caustic injury to upper aerodigestive tract 3

Ocular and Dermal Exposure Management

Eye Exposure

• Irrigate thoroughly with normal saline (0.9% sodium chloride) 1
• Instill local anesthetic to reduce discomfort and facilitate decontamination 1
• Apply fluorescein to assess for corneal injury 1
• Refer to ophthalmology if ocular injury is present 1

Skin Exposure

• Irrigate thoroughly with soap and water 1
• Treat any burns as thermal burns 1
• Note: Clinically significant dermal toxicity is uncommon (<5%) unless contact is prolonged 1

Prognosis and Risk Stratification

• >90% of exposures result in no or minor features 1
• Features develop in approximately 50% of all exposures 1
• Serious complications are rare (<0.5% for respiratory depression, <0.1% for CNS depression, <0.5% for esophageal/gastric injury) 1
• High-risk populations: Adults with cognitive impairment (9 of 17 reported deaths had cognitive impairment) 1
• Laundry pods cause more severe toxicity than traditional liquid detergents, requiring different triage approach 4