What are the symptoms in pediatric patients who ingest laundry detergent pods?

Symptoms of Laundry Detergent Pod Ingestion in Children

Children who ingest laundry detergent pods present with a distinct and severe clinical syndrome characterized by rapid-onset vomiting, central nervous system depression, and respiratory compromise requiring immediate emergency evaluation and potential airway management. 1, 2

Primary Clinical Manifestations

Gastrointestinal Symptoms

• Vomiting occurs in the majority of cases (78% of hospitalized patients), often presenting as the initial symptom within minutes of exposure 1, 3
• Nausea and oral irritation are common early complaints 2
• Abdominal pain may develop as part of the gastrointestinal response 4

Neurological Symptoms (Critical Warning Sign)

• Central nervous system depression occurs in approximately 22% of hospitalized children, manifesting as lethargy, decreased level of consciousness, or altered mental status 1, 2, 3
• This represents a unique and dangerous feature of pod exposures compared to traditional liquid detergent ingestions 2
• Seizures have been reported, though less commonly 3
• Mental confusion and behavioral changes may occur 2, 4

Respiratory Complications (Most Severe)

• Upper airway effects occur in 56% of hospitalized patients, including stridor, choking, and laryngeal edema 3
• Lower respiratory symptoms develop in 33% of hospitalized cases, presenting as respiratory distress, dyspnea, wheezing, or cough 2, 3
• Airway injury and pulmonary toxicity can occur, requiring mechanical ventilation 1, 5
• 67% of admitted children required intubation for airway management, highlighting the severity of respiratory compromise 3

Additional Clinical Features

• Swallowing difficulties (dysphagia) may persist beyond the acute phase 5
• Metabolic acidosis has been documented in severe cases 5
• Ocular injuries occur when exposure involves eye contact 3
• Dermal irritation can develop with skin contact 3

Critical Clinical Pattern

The clinical course is characterized by rapid onset and unexpected severity compared to traditional detergent exposures. 1, 2 Among children aged ≤5 years exposed to laundry pods, a significantly greater proportion experienced gastrointestinal effects, respiratory adverse effects, and mental status changes compared to non-pod detergent exposures 2.

High-Risk Features Requiring Hospitalization

• Three of four children in one case series required intubation, with hospital courses lasting at least one week in two cases 1
• The median age of admitted patients is approximately 1.4 years, with infants and toddlers at highest risk 3
• Approximately 34% of ingestion cases require hospital evaluation, with 9 of 41 hospitalized patients requiring admission 3

Time Course and Severity

• Symptoms develop rapidly after exposure, typically within minutes to hours 1, 2
• The clinical presentation is more severe than traditional laundry detergent exposures, with increased morbidity 1
• One child initially managed at home subsequently required intubation for respiratory distress, emphasizing the potential for delayed deterioration 3

Mechanism of Toxicity

The exact causative agent remains unclear, though evidence suggests the concentrated surfactant component may be responsible for the severe toxicity 1. The water-soluble membrane dissolves rapidly upon contact with moisture in the mouth, releasing highly concentrated detergent 2.

Critical Management Implications

A different triage approach is required for pod ingestions compared to traditional detergent exposures. 1 Practitioners must maintain high vigilance for:

• Rapid onset of neurological impairment and inability to protect the airway 1
• Caustic effects on the gastrointestinal and respiratory tract 1
• Potential need for early airway intervention before complete respiratory decompensation 3

All pediatric laundry pod ingestions warrant immediate poison center consultation and consideration for emergency department evaluation, particularly in children under 5 years of age 2, 3.