What is the treatment for harpic (bleach) ingestion?

Treatment for Harpic (Bleach) Ingestion

Immediate Management

For household bleach ingestion, immediately dilute with water or milk within 60 minutes of ingestion, ensure airway stability, and do NOT induce vomiting, administer activated charcoal, or perform gastric lavage. 1, 2

Critical First Steps

• Dilute the ingested substance with water or milk if the patient presents within 60 minutes of ingestion 1, 2
• Stabilize airway, breathing, and circulation as the absolute priority before any other intervention 2
• Contact poison control center immediately for guidance on specific management 1
• Ensure adequate ventilation of the area to prevent inhalation of toxic fumes 1

What NOT to Do (Critical Contraindications)

• Do NOT induce vomiting with ipecac or any other method - this is absolutely contraindicated and can cause additional esophageal injury 1, 2, 3
• Do NOT administer activated charcoal - it has no effect on caustic substances and may cause harm 1, 4, 2
• Do NOT perform gastric lavage - this is contraindicated in caustic ingestions 2
• Do NOT attempt neutralization of the bleach with acids or other substances 2
• Do NOT administer cathartics or induce diarrhea 2

Risk Stratification Based on Bleach Type

The severity of injury depends critically on the type of bleach ingested:

Household Commercial Bleaches (Lower Risk)

• Commercially available household bleaches (both chlorine- and peroxide-based) typically cause minimal to no significant mucosal lesions and have very low gastrointestinal toxicity 5
• These patients can often be managed conservatively without endoscopy if asymptomatic 5

Industrial or Homemade Bleaches (Higher Risk)

• Industrial or homemade bleaches are significantly more likely to cause esophagogastric lesions and require more aggressive management 5
• These patients require timely endoscopic evaluation and close follow-up 5

Supportive Care

• Withhold all oral feedings initially until the extent of injury is determined 2
• Assess and correct fluid and electrolyte balance carefully, as severe ingestions can cause electrolyte imbalances 6
• Administer antiemetics if nausea is present 7
• Consider proton pump inhibitors or H2-blockers to reduce gastric acid secretion 7

Diagnostic Evaluation

Esophagogastroduodenoscopy (EGD) is the gold standard for determining the presence and severity of corrosive lesions:

• Perform urgent endoscopy for industrial/homemade bleach ingestions or when significant symptoms are present 2, 5
• Endoscopy is generally unnecessary for household commercial bleach ingestions in asymptomatic patients 5
• Optimal timing for endoscopy is within 12-24 hours of ingestion when indicated, as this allows assessment before perforation risk increases 2

Monitoring for Complications

• Watch for development of esophageal or gastric perforation - signs include severe chest/abdominal pain, fever, subcutaneous emphysema 2
• Monitor for respiratory complications from aspiration or inhalation injury 6
• Assess for metabolic acidosis and electrolyte disturbances in severe cases 6

Common Pitfalls to Avoid

• Do not assume all bleach ingestions are benign - industrial products can cause severe injury requiring surgical intervention 5
• Do not delay endoscopy in symptomatic patients or those with industrial bleach exposure 5
• Do not use whole bowel irrigation - this is only indicated for specific toxins like zinc, not caustic substances 7
• Avoid the temptation to "do something" with activated charcoal or gastric lavage - these interventions cause harm in caustic ingestions 1, 2