Management of Calcium Hypochlorite Ingestion in a 7-Year-Old
Do NOT administer activated charcoal, as alkalis (including calcium hypochlorite) are not bound by activated charcoal and gastrointestinal decontamination is contraindicated in caustic ingestions. 1
Immediate Assessment and Supportive Care
Contact Poison Control Center immediately (1-800-222-1222) for guidance on this specific caustic ingestion. 1, 2
Clinical Evaluation Priority
Assess for signs of corrosive injury: hypersalivation, difficulty swallowing, retrosternal pain, hematemesis, or severe abdominal pain, as these indicate potential esophageal or gastric injury requiring urgent intervention 3
Monitor vital signs closely including heart rate, blood pressure, respiratory rate, and oxygen saturation, as hypochlorite can cause systemic effects including metabolic acidosis, hypernatremia, and hyperchloremia in large ingestions 3
Evaluate hydration status by examining skin turgor, mucous membranes, mental status, pulse, and capillary refill time to determine if dehydration from vomiting requires fluid replacement 4, 5
Diagnostic Workup for Corrosive Injury
Obtain serum calcium level urgently, as calcium hypochlorite can cause severe hypercalcemia requiring specific treatment with agents like zoledronic acid 6
Perform fiberoptic endoscopy and CT chest/abdomen as soon as possible if there are any signs of corrosive injury (severe pain, hematemesis, difficulty swallowing), as these are complementary in assessing severity of injury, risk of mortality, and risk of subsequent stricture formation 3
Do NOT perform gastric lavage or induce vomiting, as this was associated with complications including esophageal perforation in reported cases 7
Symptom-Directed Management
For Vomiting and Dehydration
If mild dehydration (3-5% deficit) is present: administer 50 mL/kg of oral rehydration solution (ORS) over 2-4 hours 4, 5
If moderate dehydration (6-9% deficit): administer 100 mL/kg of ORS over 2-4 hours 4, 5
For persistent vomiting preventing oral intake: administer small volumes (5-10 mL) of ORS every 1-2 minutes using a spoon or syringe, gradually increasing the amount as tolerated 4
Replace ongoing losses with 10 mL/kg of ORS for each episode of vomiting 4, 5
Nutritional Support
Resume age-appropriate diet immediately once the child can tolerate oral intake, including starches, cereals, yogurt, fruits, and vegetables, avoiding foods high in simple sugars and fats 4, 5
Do NOT withhold feeding as there is no justification for "bowel rest" in the absence of severe corrosive injury 5, 8
Critical Monitoring Parameters
Reassess clinical status every 2-4 hours for signs of deterioration including worsening abdominal pain, hematemesis, fever, or respiratory distress 4, 5
Monitor for delayed complications including esophageal or gastric perforation, which can occur hours to days after ingestion and may present with chest pain, fever, or mediastinitis 7
Watch for signs of severe corrosive injury: severe stenosis or perforation may require surgical intervention including total gastrectomy in extreme cases 6
Hospitalization Criteria
Admit for observation if any signs of corrosive injury are present, if the child cannot tolerate oral intake, or if there is concern for significant ingestion volume or concentration 8, 3
Immediate intensive care is required if esophageal perforation, mediastinitis, or severe systemic toxicity develops 7
Common Pitfalls to Avoid
Never use activated charcoal for alkali ingestions as it provides no benefit and may complicate endoscopic evaluation 1
Avoid endoscopy if not indicated by clinical signs, as the procedure itself can cause complications including perforation, particularly after vomiting episodes 7
Do not assume benign course based solely on stable vital signs at presentation, as severe complications can develop in a delayed fashion 3, 7