Laundry Detergent Pod Toxicity

Detergent Pods

 

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 ingested than 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 commonly than 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 RE1, 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 PE1, Burt MH2, Rose SR1, Cumpston KL1, Emswiler MP1, Wills BK3. 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 AL1, Casavant MJ2, Spiller HA2, Chounthirath T3, Xiang H4, Smith GA5. Pediatric exposure to laundry detergent pods. Pediatrics. 2014 Dec;134(6):1127-35. PMID: 25384489. [PubMed] [Read by QxMD]

Russell JL1, Wiles DA, Kenney B, Spiller HA. 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 RP1, Anderson IM, Lee MK, Rampa S, Allareddy V, Allareddy V. 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 MC1, Gala PK, Wolfe HA, Meaney PA, Henretig FM. 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 LB1, 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]

Sean Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

You may also like...

6 Responses

  1. James Cao says:

    As a treatment recommendation, we tend to watch these kids for 6 hours from the time of ingestion, which was the latest that we have seen significant CNS depression. Anecdotally, kids with significant CNS depression tend to have lots of emesis early on.

    Another difficult management question is whether or not these kids need to be scoped for esophageal injury. With emesis and then intubation, it is hard to predict degree of injury. I tend to recommend scopes for evaluation. Recent case series and my anecdotal experience is that these kids do not get severe burns/strictures. See reference: Smith E, Liebelt E, Nogueira J. Laundry detergent pod ingestions: is there a need for endoscopy? Journal of medical toxicology : official journal of the American College of Medical Toxicology. 2014;10(3):286-91.

    Cheers,
    James Cao

    • Sean Fox says:

      Dr. Cao,
      Thank you so much for the comment on therapeutic considerations!

      While ingestion of bleach once got a lot of attention for possible esophageal injury, we may have become somewhat cavalier about this possibility recently; however, your point about needing to consider this with the Pod exposure is important! Especially if the child is intubated, we need to have a low threshold for contacting our specialists to scope the child.

      I hope that you are doing well,
      sean

  1. April 16, 2015

    […] More: Laundry Detergent Pod Toxicity (Pediatric EM […]

  2. August 12, 2016

    […] important for us to realize that the kids are great at uncovering danger in almost everything (see Laundry Detergent Pods).  Let us review the potential hazard of Liquid Nicotine. {much appreciation to Dr. Christine […]

  3. July 21, 2017

    […] and the house is certainly not a complete sanctuary. In fact, the home can be quite hazardous (ex, Detergent Pods, Liquid Nicotine, Electricity, Firearms, and Lawn Mowers). While some of these items are obviously […]

  4. July 21, 2017

    […] Caustic Ingestions […]

Leave a Reply

Your email address will not be published. Required fields are marked *