Laundry Detergent Pod Toxicity

Originally published at Pediatric EM Morsels on February 27, 2015. Reposted with permission.

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We have discussed previously how poisonings (Childhood Injury) is one of the top leading causes of death in children.  Obviously, knowing your friendly, neighborhood toxicologist or the number to the local Poison Control Center is very helpful when working in the Pediatric ED, but it is also helpful to know some of the basics and what items should raise your concern level.  Some of the most colorful and fun-looking household items can induce substantial injury and illness in children.  Let us look at an interesting one: Laundry Detergent Pod Toxicity.

 

Childhood Poisonings

  • In the US, > 300 children / DAY require treatment for poisonings. (CDC)
  • Over 50% of all ED visits for poisoning were for children <4 years of age. (Nalliah, 2014)
  • The majority of poisonings are unintentional in young children.
  • Over 90% of exposures occur in homes.
    • Bleach is the most common exposure.
    • Primary mechanism of exposure is ingestion.

 

Laundry Detergent Pod

  • Single load capsules that contain concentrated liquid detergent within a water-soluble membrane. (MMWR, 2012)
  • The water-soluble membrane dissolves once contacted by moisture (like a toddler’s mouth).
  • In 2012, 48% of the detergent exposures involved the pod variety.
  • 22% of pod exposures were associated with inappropriate storage! (Valdez, 2014)
  • The laundry detergent pod causes slightly different presentations than non-pod exposures.
    • Pod exposure occurs in younger children (5 years of age and younger).
    • Pod exposure has a higher likelihood of leading to symptoms.

 

Laundry Detergent Pod Toxicity: Route

  • Ingestion – most common
    • Laundry detergent pods are more likely to be ingestedthan other non-pod varieties. (MMWR, 2012)
    • Accounted for at least one of the exposure routes in 90% of the laundry detergent pod toxicity cases.
  • Eye exposure – 17%
    • Causes an alkaline injury! (Whitney, 2015)
    • Irrigate with copious isotonic saline until pH has become neutral.
  • Skin exposure – 11%
    • ~2% has noted 2nd and 3rd degree dermal burns (Russell, 2014)
    • Remember to expose children and remove contaminated clothing.
    • Rinse thoroughly!
  • Inhalation – 1%

 

Laundry Detergent Pod Toxicity: Symptoms

  • Pod exposure and non-pod exposure lead to many of the same symptoms: (MMWR, 2012)
    • Eye irritation and pain
    • Nausea
  • Pod exposure does lead to some symptoms more commonlythan non-pod exposure: (MMWR, 2012)
    • Vomiting
    • Coughing/Choking
    • Drowsiness/CNS Depression
      • Unclear what the cause of the CNS depression is due to from the pods.
      • Seen in ~1 – ~8% of cases. (Stromberg, 2014)
      • Combination of altered mental status and possible pulmonary injury has lead intubation, although infrequently.

 

Moral of the Morsel

  • Laundry Detergent Pod Toxicity can cause CNS depression!
  • It is important to ask specifically if the exposure was to one of these pods.
  • It is important to do some injury prevention
    • Remind parents to keep colorful and candy-appearing items locked up and/or out of the sight and reach of children!!

 

References:

Whitney RE, Baum CR, Aronson PL. Diffuse corneal abrasion after ocular exposure to laundry detergent pod. Pediatr Emerg Care. 2015 Feb;31(2):127-8. PMID: 25422858. [PubMed] [Read by QxMD]

Stromberg PE, Burt MH, Rose SR, et al. Airway compromise in children exposed to single-use laundry detergent pods: a poison center observational case series. Am J Emerg Med. 2014 Dec 3. PMID: 25592250. [PubMed] [Read by QxMD]

Sidhu N1, Jaeger MW. Concentrated liquid detergent pod ingestion in children. Pediatr Emerg Care. 2014 Dec;30(12):892-3. PMID: 25469600. [PubMed] [Read by QxMD]

Valdez AL, Casavant MJ, Spiller HA, et al. Pediatric exposure to laundry detergent pods.Pediatrics. 2014 Dec;134(6):1127-35. PMID: 25384489. [PubMed] [Read by QxMD]

Russell JL, Wiles DA, Kenney B, et al. Significant chemical burns associated with dermal exposure to laundry pod detergent. J Med Toxicol. 2014 Sep;10(3):292-4. PMID: 24526400. [PubMed] [Read by QxMD]

Nalliah RP, Anderson IM, Lee MK, et al. Children in the United States make close to 200,000 emergency department visits due to poisoning each year. Pediatr Emerg Care. 2014 Jul;30(7):453-7. PMID: 24977994. [PubMed] [Read by QxMD]

Beuhler MC, Gala PK, Wolfe HA, et al. Laundry detergent “pod” ingestions: a case series and discussion of recent literature. Pediatr Emerg Care. 2013 Jun;29(6):743-7. PMID: 23736069. [PubMed] [Read by QxMD]

Centers for Disease Control and Prevention (CDC). Health hazards associated with laundry detergent pods – United States, May-June 2012. MMWR Morb Mortal Wkly Rep. 2012 Oct 19;61(41):825-9. PMID: 23076090. [PubMed] [Read by QxMD]

McKenzie LB, Ahir N, Stolz U, Nelson NG. Household cleaning product-related injuries treated in US emergency departments in 1990-2006. Pediatrics. 2010 Sep;126(3):509-16. PMID: 20679298. [PubMed] [Read by QxMD]

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