What is the treatment for detergent poisoning?

Treatment of Detergent Poisoning

The treatment of detergent poisoning is primarily supportive care, focusing on airway management, prevention of further exposure through decontamination, and monitoring for complications—with no role for induced emesis or activated charcoal. 1

Immediate Management Priorities

Decontamination and Exposure Prevention

• Remove contaminated clothing and perform copious irrigation with soap and water for dermal exposures, as detergents act on intercellular lipid domains and can cause skin barrier dysfunction. 1
• Do NOT induce emesis, despite historical reports of detergent solutions being used as emetics—this practice is outdated and contraindicated in modern toxicology. 2
• Oral decontamination is generally not indicated for detergent ingestions, as activated charcoal and gastric lavage have no role in this poisoning. 1

Airway and Respiratory Management

Laundry detergent pod (LDP) exposures require particularly aggressive airway monitoring and early intubation consideration, as they produce more severe toxicity than traditional liquid or powder detergents. 3, 4, 5

• Monitor closely for rapid-onset respiratory compromise, including stridor, aspiration pneumonia, and respiratory depression secondary to CNS effects. 4, 6, 5
• Consider early endotracheal intubation for patients with significant respiratory distress, altered mental status, or inability to protect their airway—approximately 75% of severe LDP cases required intubation in case series. 5
• Be vigilant for late-onset respiratory distress (up to several hours post-exposure), particularly with inhalation or aspiration of granular detergents. 6

Clinical Presentation and Monitoring

Common Toxidrome

The typical detergent poisoning toxidrome includes:

• Gastrointestinal symptoms: Vomiting (occurring in >50% of LDP exposures), drooling, and nausea. 3, 4
• Neurological symptoms: Depressed sensorium, sedation, and altered mental status. 3, 4, 5
• Respiratory symptoms: Stridor, hypoxia, aspiration pneumonia, and respiratory failure. 4, 6, 5
• Metabolic derangements: Lactic acidosis and metabolic acidosis. 3, 4

Risk Stratification

Approximately 10% of LDP exposures result in major or moderate effects, with the most severe cases occurring in children under 3 years of age. 4

• The absence of oral burns does NOT exclude esophageal injury—all three patients in one case series developed esophageal erosions despite no oral findings. 3
• LDP exposures are significantly more toxic than traditional detergent exposures, though the exact mechanism remains unclear and may relate to surfactant concentration or delivery method. 3, 4, 5

Specific Interventions

Endoscopy Considerations

Upper endoscopy should be considered if gastrointestinal symptoms persist, particularly dysphagia or ongoing vomiting, though esophageal stricture formation appears rare. 3

• Esophageal injury can occur even without oral lesions, with findings ranging from superficial erosions to erythema. 3
• Long-term stricture formation is unlikely based on available literature, but follow-up upper GI studies may be warranted for persistent symptoms. 3

Supportive Care Measures

• Provide aggressive fluid resuscitation and correct metabolic acidosis as needed. 4
• Monitor oxygen saturation continuously and provide supplemental oxygen for hypoxia. 4, 6
• Treat seizures or agitation with benzodiazepines if they occur, following standard poisoning management protocols. 1
• Observe for at least 6 hours even in asymptomatic patients, given the potential for delayed respiratory symptoms. 6

Common Pitfalls to Avoid

• Do not rely on the absence of oral lesions to rule out esophageal injury—the correlation is poor in detergent exposures. 3
• Do not underestimate LDP exposures—they require more aggressive management than traditional detergent ingestions. 4, 5
• Do not discharge patients prematurely—late-onset respiratory distress can occur hours after exposure. 6
• Do not attempt gastric decontamination—it provides no benefit and may worsen outcomes. 1

Consultation and Follow-Up

Contact a regional poison control center (1-800-222-1222 in the United States) for expert guidance, as board-certified toxicologists can provide case-specific recommendations. 1

• Admit patients with significant symptoms (respiratory distress, altered mental status, persistent vomiting) for observation and supportive care. 4, 5
• Hospital courses may extend to one week or longer in severe cases requiring mechanical ventilation. 5