Is bleaching powder a corrosive substance that can cause poisoning?

Is Bleaching Powder Corrosive and Can It Cause Poisoning?

Yes, bleaching powder (sodium hypochlorite/bleach) is a corrosive oxidant that can cause poisoning, though most household exposures result in mild injury while massive ingestions can cause severe, potentially fatal corrosive damage to the gastrointestinal tract. 1

Mechanism and Severity of Toxicity

Bleaching powder's toxicity stems from two primary mechanisms:

• Oxidizing capacity and pH-dependent corrosive activity upon contact with mucous membranes, skin, and gastrointestinal tissues 2
• Concentration-dependent injury patterns: Household bleach (typically 3-6% sodium hypochlorite) usually causes mild injuries, but severe damage requiring emergency resection has been occasionally reported, particularly with massive suicidal ingestions 1

The extent of injury depends on the concentration, volume ingested, duration of contact, and whether ingestion was accidental versus intentional 1

Clinical Presentation and Complications

Mild to Moderate Exposures

• Small accidental ingestions are unlikely to cause clinically significant toxicity 2
• Typical symptoms include sore throat, mucosal irritation, and mild gastrointestinal discomfort 1, 2

Severe Exposures (Large Volume/High Concentration)

• Corrosive gastrointestinal injury with potential for esophageal perforation, mediastinitis, and transmural necrosis 1, 3
• Systemic effects including metabolic acidosis, hypernatremia, and hyperchloremia 2
• Respiratory complications including ARDS when aspiration or inhalation occurs 4
• Fatal outcomes have been documented with massive ingestions 5

Critical caveat: Clinical symptoms do not reliably correlate with the extent of gastrointestinal damage—absence of oral lesions or pain does not rule out life-threatening injuries 1

Immediate Management Algorithm

First Aid (Pre-Hospital)

1. Do NOT induce vomiting or administer ipecac—this is contraindicated and causes harm 6
2. Do NOT give water, milk, or activated charcoal unless specifically directed by poison control 6
3. Remove contaminated clothing and perform immediate decontamination for skin/eye exposures 1
4. For skin exposure: Brush off any powder before water irrigation to avoid exothermic reactions 1
5. For eye exposure: Irrigate immediately with copious tap water for 15 minutes 1
6. Contact Poison Control Center immediately for guidance on systemic toxicity management 1, 6

Emergency Department Evaluation

Laboratory assessment should include 1:

• CBC, comprehensive metabolic panel (sodium, potassium, chloride, magnesium, calcium)
• Liver function tests (bilirubin, ALT, AST)
• pH and serum lactate
• β-HCG in women of childbearing age

Imaging evaluation 1:

• Contrast-enhanced CT of neck, chest, and abdomen (performed 3-6 hours post-ingestion) is superior to endoscopy for detecting transmural injuries
• Absence of post-contrast wall enhancement indicates transmural necrosis and is an indication for emergency surgery
• Plain radiographs may show free air indicating perforation

Predictors of Severe Injury Requiring Surgery

The following findings predict transmural necrosis and poor outcomes 1:

• Severe acidosis (low pH, elevated lactate)
• Deranged liver function tests
• Leukocytosis and elevated CRP
• Renal failure
• Thrombocytopenia

Definitive Treatment

• Symptom-directed supportive care is the mainstay—there is no specific antidote 2
• Gastrointestinal decontamination is NOT beneficial and should not be performed 2
• Fiberoptic endoscopy and CT are complementary for assessing severity, mortality risk, and stricture formation risk 1, 2
• Emergency surgical resection is indicated when CT demonstrates transmural necrosis (absent wall enhancement) 1
• Delayed complications include esophageal stricture formation requiring long-term management 3

Special Considerations

• Intentional ingestions in adults with psychiatric disease typically involve larger volumes and require aggressive emergency management 1
• Pediatric accidental ingestions are usually small volume and rarely cause severe injury 1
• Ammonia-containing bleaches require specific surveillance as superficial hemorrhagic gastritis may progress over 24-48 hours 1